Recovering From Hypothalamic Amenorrhea (Episode 349)

Full Transcript: Episode 349

This is the Fertility Friday Podcast, episode number 349.

Lisa Hendrickson-Jack: 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 charting journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control 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 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. I know, I know, I’m a busy girl, but I managed to fit it all in. 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 us today.

Lisa Hendrickson-Jack: Today’s episode is all about HA, Hypothalamic Amenorrhea, and I’m excited to share my conversation with Samantha Kellgren. We’re talking about her experience with HA, how she overcame it, and some of the specific challenges that women face when they’re dealing with HA. And I think one of the, to this day, most astounding issues with HA, and I mean other related period issues, but today we’re highlighting HA, is that many women seek support for these challenges, and they’re not really provided even with the basic information about how this works. And so we get into that and so much more in today’s episode. And let me just take a moment to share Samantha’s bio. Samantha is an exercise and mindset coach, helping women take control of their fertility through the mind-body connection so they can level up their life. After being diagnosed with Hypothalamic Amenorrhea, finding out it’s possible to be too fit to get pregnant, and undergoing IVF to have their son, Samantha made drastic changes to her unhealthy relationship with exercise and healthy eating. She now helps other women through the major mindset shifts it takes to stop over-exercising and under-eating so they can regain their cycles and get pregnant without going crazy. So without further ado, let’s jump into today’s episode with Samantha.

Lisa Hendrickson-Jack: So, thank you for coming to the show, Samantha. Welcome.

Samantha Kellgren: Yeah, thanks for having me.

Lisa Hendrickson-Jack: Well, I’m excited to have you on the show. As you know, I’ve certainly talked about HA, Hypothalamic Amenorrhea, many times on the show, and so I’m really excited to get into it with you today. I’d love to start by giving you an opportunity to share about your personal experience and kind of what led you to be focusing on this area of women’s health.

Samantha Kellgren: Yeah, yeah, so like a lot of women with HA, you don’t know what it is until you are looking at fertility treatments and kind of deep in, and that was my experience. I was a marathon runner, I was actually a running coach, I helped train people training for the Chicago Marathon. So I was a personal trainer, very into fitness, and that’s kind of who I was. I ran my seventh marathon before going off the pill, and I was on the pill for 13 years straight. And so I have no idea when I lost my period, because I went off and it didn’t return, and I wasn’t alarmed when it didn’t come back right away that first month, it was like this is kind of expected, but after three months with nothing I went to my OB and said, hey, what’s happening, what can we do, we’re ready to get pregnant, naively, we’re ready to go off the pill and get pregnant. And we did the Provera challenge, we did that twice with no bleed. She said, she knew that I was a runner, and she said, you might need to back off your running, but that was the only direction in that case. So it was, what does back off mean, what does do less mean to me versus someone else, how is all that tied together, none of that information came out. It was, we sometimes see this in runners, you might need to back off. Okay, so after failing that Provera challenge twice, I was sent to an RE, we found tubes were open, everything looked quote unquote normal, except I had no uterine lining, my estrogen was so low, there’s nothing to bleed out. So that’s why it didn’t work, that’s why I wasn’t getting a bleed, I had no estrogen, everything had been suppressed. And that’s when it got more serious, it was like, oh, this is not just, I’m missing one little link, this is, you have no estrogen, you have nothing to bleed out, even if everything aligned you couldn’t hold on to an embryo, there’s nothing happening. He said, with such low estrogen, estrogen is body fat, you clearly have low body fat, you probably need to put on some weight. So the signs were there that I needed to cut back on exercise and put on weight, but the entire time working with him, through IVF and having my son, I was listed as unexplained infertility. That’s very shocking looking back now, I mean, if I had just not done any outward research, or found podcasts like yours, if I did not look into anything, I would not have still known Hypothalamic Amenorrhea was a thing and what was going on. I needed more information, as someone with HA, I know anyone with HA can relate that if you are told to cut back, you need numbers, you need what is safe to do, how does all of this go together. I needed the bigger picture and I didn’t have that, I needed to be told, look, you need to cut out running, because I cut back, but I didn’t have any direction on what is doing less, how much weight do I need to gain, what is my goal, I needed a goal instead of this wide abyss of put on some weight and cut back on your workouts. So I did cut back running, but I was still running a few times a week. We did one IUI that failed, and we tried four more rounds that all got cancelled because I was not responding in the way that I needed to.

Lisa Hendrickson-Jack: When you say you weren’t responding, does that mean you just didn’t ovulate in response to the ovulatory-pushing drugs?

Samantha Kellgren: Correct, yes, yes. So the follicles weren’t growing like they needed to, I just wasn’t responding.

Lisa Hendrickson-Jack: Can I just, I’m interjecting, but there’s a couple things that I wanted to just highlight because I think it’s important parts of your story, and then I also have a couple questions, of course I do. But one of the interesting things that you said was that the doctor did some testing and discovered that your endometrial lining was thin and discovered that you had low estrogen, and then told you as if it was like this big surprise, and then you responded like, oh my gosh, I have low estrogen. So when you understand the menstrual cycle, and you understand that the only reason that you produce estrogen is when you’re approaching ovulation as the follicles develop, then of course you don’t have sufficient estrogen if you’re not ovulating. So when I hear that, I think this is kind of catastrophizing, at least kind of like one way to describe an issue, like, oh my gosh, low estrogen, as if it’s just low and we don’t know why, right, but what’s really happening is that you’re not ovulating. If you are not ovulating, if you are not developing a follicle, then you’re not going to be producing estrogen, because our estrogen is produced by that follicle in our ovary as we approach ovulation. And in HA, you are not approaching ovulation, that’s the reason why there’s nothing happening. And of course estrogen is what builds the uterine lining. So I get a question from clients a lot, like what testing do you think I should have, and if I worked with someone who had HA, for example, and they said, should I test my estrogen, should I get an ultrasound, I’ll never tell anybody what to do, so sure, if you want to have those things tested, but I’m not like an oracle, but I can tell you what the results are going to show, because if you are not ovulating, you’re not going to have a significant endometrial lining, of course you’re not. And if you’re not ovulating, well, you’re never producing any cervical fluid, it means that your ovaries are not responding. So I just wanted to kind of point that out. And then also a couple interesting things, like when you have HA, we didn’t define it, but the three main characteristics of HA are over-exercise, under-nutrition, and stress. And so that is the underlying issue. If you are exercising too much and not eating enough to cover the output, then your body is actually starving, so that is the issue, the issue is that your body is starving. And when your body is starving, it’s kind of like, okay, so we’re going to put aside ovulation for a minute, because it’s not a good time. And so the medical approach to this, as you’re describing, giving you the Provera, so giving you progesterone to try to kickstart your ovulation, it’s a very interesting approach, because if you’re starving, why am I giving you progesterone, why am I not giving you food and telling you to cut back, you know what I’m saying?

Samantha Kellgren: Yes, thank you, yes, yes. And to tell someone they need to gain weight, but not to put in those terms of, this is your energy deficit and your body thinks it’s starving, it’s not that your body thinks it’s starving, it’s that your body is starving. Yes, and the end result is you need to eat more, but it’s a different mindset and different way to look at it, I believe, than just, I need to put on weight, it’s, I need to look at the bigger picture of what’s going in and what’s going out, and what is this stress, and that was not explained.

Lisa Hendrickson-Jack: Yeah, I mean, it’s so common, I’m sure there are women who tuned into this episode specifically because we’re talking about HA, and have had similar experiences of basically having a known condition but to not even have that necessarily be named or described or told to you, and to have to then go outside of your highly trained medical doctor to find literally the words that you would have to search online to find information, is just insane. A couple other questions I wanted to ask you, you mentioned that you were on the pill for 13 years, I’m just curious if you remember, even when you went on the pill, were your periods normal at that time?

Samantha Kellgren: When I first went on the pill, I came off it at 31, I went on it at 18.

Lisa Hendrickson-Jack: So you had already had a couple years of cycling.

Samantha Kellgren: Yes, yes, and I was very regular, I don’t remember having any issues with it, I’d get some painful cramps but nothing out of the ordinary, I could feel that I had a period but it was not debilitating, it was not an issue.

Lisa Hendrickson-Jack: Well, and I have one other question, while you were taking the pill, your pill periods, so now you know they were withdrawal bleeds, not true periods, but your pill periods, were they still happening and still like the same, had they changed, lighter or heavier, or were they kind of still the same?

Samantha Kellgren: They were pretty much the same, I don’t remember noticing a difference.

Lisa Hendrickson-Jack: I just ask that because an interesting phenomenon that I’ve encountered many times when speaking to women with HA, some women have their pill periods, their withdrawal bleeds, when they have their sugar pills or their seven days off, and some actually stop getting their pill bleeds, and then they go to their doctor and it’s like, oh, it’s totally fine. So just for anyone who’s listening to know, it’s interesting that your period could still be a vital sign in a way, but obviously it doesn’t happen to everybody, but if you are on the pill and you’re still taking your week off, and you stop getting that withdrawal bleed, that’s something to know, that could be a sign of HA. But in your case you did not have that, so when you came off, you had your regular bleeding for 13 years and then you came off and then nothing, and how long did it take, in your case did you start cycling naturally, or did you just have to eventually get IVF?

Samantha Kellgren: We went into IVF, right, we went into IVF because, like I said, I didn’t have that language, I didn’t have this word, and with unexplained, I think that’s an aspect of it, but I don’t think it’s the whole thing.

Lisa Hendrickson-Jack: Well, it’s not unexplained.

Samantha Kellgren: Thank you.

Lisa Hendrickson-Jack: I mean, of course, I am not a medical doctor, so I don’t give diagnoses, but when you understand the menstrual cycle, it’s not even that in your case it was a mystery, it’s not like it’s this rare condition that only a fraction of a percent of the population ever gets, HA is a fairly common issue that practitioners should be aware of, and there’s plenty of information in the literature of the signs, what to look for, and the literature talks about the importance of actually addressing the energy deficit. So maybe share a little bit then, continuing, because I did interject, share your experience and then go into some of the challenges that women with HA are facing in our medical system.

Samantha Kellgren: Yeah, so really, when I found out HA was not through the doctor I had, I went to an event, fast forward, this was, I went off the pill in February of 2016, we were trying these failed IUI rounds through almost January, then we’re looking at IVF, so a year later, and we got two embryos, we do the first transfer and it is a chemical pregnancy, so it shows my body can get pregnant, it didn’t take. I go to an event, a fertility event, so glad I went, but I talked to another doctor there, and immediately she says, you sound hypo, and I’m like, come again, what is this? So she gives me a name, I looked online, I took to Google, but now I have this name and every single thing I’m reading, I’m like, yes, yes, me, me, all these things, this is it. And it felt as good as it felt to have a name for it, because then you feel like you have more of a plan. My instant thought was, well, I did this to myself, like, I’m the reason we are doing IVF right now, I am the reason, I did this to me. But that thought didn’t last very long, because it was like, okay, well, I can sit here and think that and get nowhere, or I can think, if I did this, now I know how to undo it, and that is going to be my new goal, is how can I undo this. But with that comes the reason I am working with women through this, is because it is way easier said than done to eat more and work out less. Women that tend to have HA, we have it because there’s an aspect that we love working out, that it’s part of who we are, we like this control aspect, we like a plan, we like a schedule, and to suddenly have that taken away, when he said you might have to stop running, it was like, well, that’s no, I’m a runner, I coach runners, I’m a trainer, this is what I do, this is who I am, I’ve been running for a decade, what do you mean just cut it off, what do you mean don’t run, don’t stress about it, right, because stress isn’t good. So to find that new way to approach exercise, and things come up with, oh, I actually am, I didn’t think I had a fear of gaining weight but I do, because I’m afraid if I stop running, if I eat more, what’s going to happen to my appearance, what’s going to happen to my body, and all these things happen at the same time.

Lisa Hendrickson-Jack: Well, let’s dig into it, because what you said is really important, there’s a difference between basically knowing the path, understanding it, and walking it, and there’s a reason why women are doing these things, and there is a very real emotional aspect attached to it. I want to ask a few questions that are pretty direct, is it an eating disorder, looking back, is it some sort of disordered pattern, the reason that I’m asking that is because there are certain characteristics that you often see in women with HA, and I feel like you just have to call it out, I mean, I have some of these characteristics myself, being really type A, wanting things to be a certain way, wanting to be in control of something, particularly certain, because you can’t be in control of everything, but this is the thing that you need control of, also body image, so being really attached to a very thin image. Even when you look in the literature, what’s interesting is that HA is more common in sports that emphasize thinness, so ballerinas and gymnasts, and sports where your body is actually weighed and you wear a leotard.

Samantha Kellgren: Yes.

Lisa Hendrickson-Jack: So talk to us a little bit about these aspects, because it’s exactly what you said, it’s not just eat less exercise more, or eat differently.

Samantha Kellgren: Well, I said the exact opposite, eat more exercise less, it’s not that simple either, it’s not just as simple as being like, okay, eat more food, exercise less, I’ll see you next week. So for me personally, I would say I did not have an eating disorder, I had disordered eating for sure, disordered mindset around food and feeding myself, we very briefly talked about diet culture and this thin ideal, and how many times is it written that you should have a certain low number of calories. Calorie counting has messed up the world, I don’t count calories anymore, so much easier, but I was counting, and I tried to keep it under a very low number when I was marathon training, because I thought even the upper end of what I’d read was still too high. This reminds me of one of my interviews with Nicola Rinaldi, because she wrote what I call the HA bible, so for anyone who’s listening, I’ve got it here, I’m sure you do too, but one of the things she talked about is having to explain that it’s not just the energy that you expend when you exercise, you have to actually explain that you also need energy to just exist, your body heat, the digestive processes, it’s like you have to explain that you need more energy than just to offset your exercise, because your body is a functioning amazing unit that actually requires energy to do everything. But what we see is how many posts do you see around holidays equating if you eat this you have to do this many jumping jacks to burn it off.

Lisa Hendrickson-Jack: They are doing, you’ve got to unfollow those people, I don’t have those types of posts in my feed.

Samantha Kellgren: Yes, that is, I say the only healthy detox is a social detox, and unfollow those, I don’t have things like that in my feed, if anyone’s listening and your feed is full of that, you need to change your feed.

Lisa Hendrickson-Jack: Yes, yes, that is, agreed. I mean, a lot of my clients I talk about, okay, do you have a Fitbit, I’m like, take it off for now, because you’re obsessed over those numbers, and do you ever think about those days that you feel exhausted when you traveled and you were in the car sitting for eight hours, but you’re exhausted, it’s because you didn’t physically move but you had plans, you are packing, you are thinking about the timing, you are driving on the road and making sure you are safe, it is this expenditure of energy that your steps aren’t counting because it’s not physical, but it is a real energy that you need to support, and it is a real drain, that if you don’t recognize it in that way, you’re not going to adjust everything else appropriately, because you’re going to get out of that car and say, I need to go for a run, I need to offset all of this sitting, when you’re layering on another stress, that would be a hard place to live in, to be constantly afraid of gaining weight.

Samantha Kellgren: It is, and I think that the body image is this underlying thing, and the guilt, of, you know, I took a rest day, well, I took a planned rest, I did not take unplanned rest days, that’s a totally different thing, I felt extreme guilt if I had to cut a workout short or something happened and I couldn’t get it in, that really happened, I usually pushed through, that is the unhealthy side of this.

Lisa Hendrickson-Jack: You said something really interesting earlier, I think I took a note, let me see if I wrote it down, or maybe I can remember, I feel like you said that before your doctor told you to cut down on running, you ran a certain distance a week, and it just rattled off the tongue, as if it’s nothing, and then you said you cut it down to less.

Samantha Kellgren: Yeah, yeah.

Lisa Hendrickson-Jack: So what’s interesting again, from when I was researching, and I know it’s different obviously, research is not the same thing as what’s happening in an individual woman’s life, but I think it’s interesting, there’s this one study that I looked at, and they had women who had lost their periods who were exercisers, and one of the things that they did is they had the women continue their exercise routines, but they had them consume an additional beverage that contained protein, fat, and carbohydrates, essentially the caloric equivalent of an additional meal every day. So these women had previously had disordered eating patterns, and had been assessed as no longer having disordered eating, so these women had received whatever support they needed to get back into eating regularly. So these women were eating their regular meals but would also consume this caloric supplement, an additional meal to their regular meals, and within several months the majority of these women had actually resumed cycling. So it’s interesting, because for most women with HA, the concept of consuming an additional meal would make it such that it would be likely easier to significantly reduce the exercise, address that, and then look at the diet, but I just wanted to say that to give an example, that if you’re just living your life you need to have a good amount of calories every day without exercising, and if you’re an athlete, you might not identify as an athlete, but running the mileage that you were running is athlete level.

Samantha Kellgren: Right, you know, at the time, would I have identified as athlete level, no, I was a runner, and I surrounded myself with those people, and that’s the thing, right, because if that is what your feed is, and that’s why you clear out those people, because if that’s what you’re seeing, that’s normal, right, if I make a lot of friends through one group, if I am a personal trainer in the gym, that’s what I’m seeing is normal, and that’s why I feel like it’s so important we need to be told, no, this is you are at this level, you need to, this is where you need to be, instead of just cut back, because if you’re an athlete, you have to acknowledge and own that athletes need to make sure that they’re consuming excellent diets with more than sufficient calories, you have to understand that, and then also you have to get sufficient sleep, and you want to support your muscles and all of these things, because you’re basically at an elite level, and a lot of women with HA don’t realize that their intensive workout plan is well over and above athlete level.

Samantha Kellgren: It is, and I think it’s a slow slippery slope to get to that, you didn’t go from not working out to running that many miles a week, you slowly inch it up, and that is your new normal, this is how much I run now, and if someone tells you to back it off, you’re thinking that a big reduction might even be light, it’s insane, the amount of working out I do now, I still love, I still like to move, I still like exercise, but it is such a different way, for one, if it doesn’t make it into my day, I’m okay with it, it is not that I need to make up for it, it was my plan and it didn’t happen, okay, it’s so much less stressful, just on that aspect of it, just that mental aspect of trying to get these things in. I run a handful of times a month now, and when I run it is because, I ran two days ago because the weather was amazing and my husband was home to be with our toddler and I was like, I think I’d like to go for a run, that’s why I ran, it is not to hit a time goal, is not to hit any other goal, but this is how I want to move my body today. But I don’t think I could have gotten there if I didn’t completely take it out, I completely stopped running for nearly a year before our transfer, through my entire pregnancy and then some after, because I thought I need to completely take this break from it, and for one, see if I still like running, maybe it was something I was holding on to, I think that’s where a lot of people get into, I’ve talked to clients before that say this has been my routine for so long and I don’t know how to change it, because this is who I am and this is what I do, what would I be if I didn’t do this, what do I do with that time, it really becomes who they are, and it’s scary, of course it’s scary to suddenly say you can’t do this or this needs to look differently, you don’t know where you need to be and how to get there.

Lisa Hendrickson-Jack: Well, I really appreciate the power of words, because you said it’s hard to say that you can’t do this, well, you can do whatever you want, the question is what is the outcome that you want, or what is the goal that you have. So my question for you then, for a woman who’s listening who just recently found out that she has HA, she got the name somewhere and this is what she’s researching, so if she’s struggling with a similar issue with exercise, coming to terms with the fact that this is a known issue, over-exercise, under-nutrition, and stress is the trifecta of period disappearance, non-ovulation, and she wants to start ovulating again, and she has that intuitive sense that she’s going to have to look at her exercise, so how do you go from working out very hard and often, how do you go from that? Now, you said in your case that you cut it out completely for a period of time and you felt like that was necessary for you, so if you’re working with women who are struggling with this, how do you approach it, what is your suggestion, how do you change the pattern?

Samantha Kellgren: Right, so mindset is a huge thing, but I feel that’s vague, so we’ll get to that second, first off I think look at what do you like about your workouts, what are you getting from them that you do look forward to, and when I looked at it, the running was alone time, it was time to be with my own thoughts, to not talk to anyone, to be outside, to listen to my music, my podcast, whatever I want, and to get the endorphin rush thing. Well, you can get that without running, I love walking now, can you go for a hike, what is something that is physical but nourishing to your body, that gives you the mental boost that you’re looking for but isn’t a pounding intense exercise, how much can you keep from what it is you like about the workouts you’re doing but alter it so it’s in a healthy way, that’s the number one thing, because it’s going to be super stressful if I say you can’t do any of this, deal with it, right, but it’s, hey, what do you like about this, what can we keep from it that would be somewhat similar and get used to it, and it’s sustained in doing it over time, because that first week or two felt like it was like a weird vacation of, I’m doing something I shouldn’t, like I’m taking a break from running for a week, and oh this is weird, but this isn’t normal, it’s making that your new normal of, no, this is how I get my exercise now, and this is what I do, and just continuing to do it until it feels not weird anymore. But the mindset part came to me, it’s these damn Facebook memories, that as I was trying to cut back, I would get these memories of me finishing a marathon or a long run, and I had no body fat, and I would see that and my instant thought for a while was, I can’t wait to get back there, I can’t wait until I can do that again, and suddenly I saw the whole picture, and it was, do I really want to get back there, why do I want to get back there, what do I want out of that, because there was a lot of stress around making sure I got my long run in, or if we were going away for a long weekend, how can I make up for those runs, this is all me, right, and was that fun, was that enjoyable, because that aspect wasn’t enjoyable. So really painting the whole picture of, okay, you say you don’t want to lose this and you can’t imagine a different way, but are you really happy with how things are right now, with the whole picture of how things are, because I could find flaws with how I looked with no body fat, so that means I’m never going to be happy with it, and it’s those same things, I’m heavier now, I have much more body confidence, it doesn’t hit me if I see a bad picture from a bad angle, I’m like, oh, and I move on, it’s not, oh, I need to eat differently, I need to work out more, I need to change this, it’s a totally different approach, and that comes from realizing, hey, things weren’t perfect then, why do I want to hold on to this, why do I want to get back there, let’s look ahead at how could I live, what would my day look like if I had more body confidence, if I wasn’t only thinking about how I look, what I’m eating, what my workouts are like, what would my life be, because you’ve kind of narrowed it down to this tiny thing, and let’s open it back up and look at what do you really want out of your day, what really excites you.

Lisa Hendrickson-Jack: Oh yeah, there’s so many important nuggets in what you said, and I just want to highlight when you said the word perfect, because that’s what this is about, I mean, I don’t know if you could sum up HA in a nutshell, but let me try, go with me for a second, isn’t this about being perfect, isn’t it about having the perfect body, isn’t it about being at the perfect weight, isn’t it about having the perfect routine, isn’t it about having the perfect amount of calories in so that you can have this perfect body?

Samantha Kellgren: Yeah, yeah, it’s so much of tying your exercise to your eating, which is diet culture and what we’re shown to do, but if you can untie that and look at it as totally separate things and separate reasons why you’re doing that. I just got off a call with a client and she said, I need things to be perfect, and I said, okay, but why are we on this call today, because things aren’t, it’s not making you happy, you’re doing these things that are quote unquote perfect but you’re not happy with how you’re living, so in that sense it is not perfect.

Lisa Hendrickson-Jack: Well, and I have a few thoughts to share about that idea of perfect as well, because when you were describing your body, when you said I’ve put on weight and I look in the mirror and I don’t think, oh this is bad, and then you said when I looked at memories when you had no body fat, you could still find flaws, I thought that was a really important point, but your current bigger weight, which outside of the context of your running friends I’m sure the world thinks you’re pretty skinny.

Samantha Kellgren: I am, I am, just to put that out there.

Lisa Hendrickson-Jack: Right, because it’s all about perception, so for a woman who’s been chronically underweight for years, when she puts on some weight, she looks skinny, because outside of her perception, outside of that kind of small special interest group, getting out here, outside of that small group of people around you that are also very on this exercise thing, compared to the rest of the world, but it’s not about that, it’s about being perfect, but I just wanted to say, like, your bigger body, which is small, brought you your child, this perfect diet, this perfect exercise routine, lost period, it basically suspended your body’s ability to ovulate and menstruate, it basically shut down your endocrine system, or at least a very important aspect of it. So just to share a thought, because I look at the menstrual cycle in a very different way, I look at it as a vital sign and it’s the center of my practice, so every client that I work with, the menstrual cycle, the chart is up in the session, and we’re always talking about how it links to whatever it is, whether it’s birth control or health, so it’s interesting, right, because we have this idea of perfect, so show me your menstrual cycle and I can show you your future, I just like to be silly with puns, but I guess what I’m saying is, if I’m working with somebody and they’re at what they would consider to be their perfect weight and they have their perfect routine and they have their perfect situation, and we pull up the cycle and she’s not menstruating, or we pull up the cycle and she’s got premenstrual spotting or a short luteal phase or whatever the case, then the actual physical body is what is telling us whether or not what you’re doing is working. So instead of thinking about perfect, there’s no such thing as a perfect cycle, perfect body, perfect anything, perfection is just not a real thing, we could look at it in terms of what’s working and what’s not, and if your menstrual cycle isn’t in an optimal range, it’s not working.

Samantha Kellgren: Yeah, yes, yes, yes. And to show how much it is in your head, I put up a before and after of probably near my thinnest, and a week or two ago most of the comments said I cannot tell a difference, because it is in your head, you feel, I mean, fat is a feeling, you feel fat because you’ve been restricting so long, because you don’t know your hunger cues, because you’re eating what you should actually be eating but you haven’t been doing that for so long, it feels different, but it’s not, it’s welcome to normal society, welcome to this is how much you should be feeding yourself, but you haven’t been doing it for so long that it feels like a lot, but it’s so internal and it’s so how you view yourself, and in the best way, no one else cares about you, no one else cares if you put on some weight, no one, because no one’s like weighing you with a microscope, and I think that you get on the scale and if you’re upset by this number, you are not walking around in the world with a number over your head, people are feeding off of your energy and who you are, they don’t know what you weigh, no one knows that but you, and you are the one carrying that, so if you can loosen up and not tie so much to that and tie so much into a size, it just, life really opens up and it’s so much easier, and I feel like everyone I talk to that gets their period back, like the getting the period back or getting pregnant was their goal, but in the end that is just this added benefit of all of these other things that they experience and get out of getting their cycle back, like, yeah, I got my cycle back, but oh my god, I’m not cold anymore, I don’t have these obsessive thoughts over what I’m going to feed myself, I let my husband cook dinner for us because I’m not micromanaging what’s going into it, I mean, there’s so many little things that really open up and take all the stress off and open your days to such greater experiences, and you got your cycle back, it’s this bigger picture, and that’s what I try to keep women focused on, is how do you want, in 10 years what do you want that to look like, what do you want your life to look like, because is it working right now, it’s likely not.

Lisa Hendrickson-Jack: Well, and you said something, I’m not cold anymore, so previously we talked about HA and how your body is actually starving because you’re not consuming sufficient calories to offset your caloric deficit that was brought on by your exercise routine, for example, and it’s interesting because if you starve your body, your body has to adjust, our bodies are amazing, so what we consider to be a problem, like losing your period, is actually your body protecting you and adjusting to the environment that you have created.

Samantha Kellgren: Yes.

Lisa Hendrickson-Jack: And so if you create an environment where you’re not consuming enough food, then your body has to compensate for that by lowering your temperature, lowering your metabolism, running cold, so that it preserves the minimal energy you’ve provided it, and so for example when you’re charting and you see that the temperature is low, I know a lot of women are like, oh, I must have a thyroid issue, well, are you eating three meals a day every day, because sometimes you’re cold because you’re actually not getting enough food, and your body has to compensate for that lack of energy by lowering your body temperature and your heart rate, and we see really low heart rate with this too, of course, because your body is running like it’s like you expect your car to run without providing sufficient gas, except that our bodies are not cars, so our bodies are incredible and able to adapt to this situation. One of the questions I wanted to kind of pull back to, because you were talking about diet and changing how you’re looking at even the number, the weight, so for someone who’s listening, because this is exactly what we talked about at the very beginning, it’s so much easier said than done to sit here and say, don’t stress about the weight number, be okay with it, throw away the scale, eat more food, it’s so much easier said than done, so I want you to talk about that, and one question into that that I always have, because I don’t know how much I weigh, weighing myself is not a thing I like to do, if anything I’ll go by how I fit into my pants, so I’m not saying that I’m foreign to understanding the size of my body, I’m just saying that just to put a perspective out there, like there are women out there who don’t actually weigh themselves and I’m one of them, but with that said, the question is, how do you divorce yourself from your hunger cues?

Lisa Hendrickson-Jack: I cannot understand to this day how you could get to the point where you’re restricting so much and exercising so much and like you’re hungry, so talk to me about how that works, and then how, after all those years of ignoring the hunger cues, and you’re super type A, this is like an accomplishment, right, you’ve won over your own body’s cues, that’s not the right word, but I think you know what I’m trying to say, it’s almost like an accomplishment except it’s not one that you would want to strive for, so how do you switch it up and start listening to when you’re hungry, how does that work?

Samantha Kellgren: Right, and I think that it comes from that control, right, it’s when you say I want control over my body, okay, I’m the one in control here, my body is hungry but I want to eat on the schedule, a lot of this schedule of I’m not going to eat breakfast before a certain time, whatever, I eat every three hours but I’m not going to snack in between, whatever these small food rules that you create, it’s one by one, you don’t sit down one day and say this is how I’m going to eat, it is, maybe you read somewhere that you shouldn’t eat past a certain time, so that’s now your rule, you’re collecting all this incorrect information and really making that what you go by, and ignoring, you start to ignore, I shouldn’t be hungry yet, I just ate, I shouldn’t be hungry, that’s a big one, well, no, your body is cycling, it should be cycling and you’re going to need different calories at different times, but you ignore that because you feel like it should be a clean slate, and this is what I do, this is how I eat, this is when I eat, this is when I should be hungry, and you just get so into sticking to that routine that you stop, you ignore it, and like I said, I feel like it’s a slow evolution, to where I had certain food rules, getting out of that, a big part of it is that you have to want to be out of it, and I think that it’s first that mindset, just like I feel like I would get, I finally got so much more frustrated that I still cared about weight or how my body looked, I was more upset that I was still upset about it, and it was like, okay, now it’s time to change, I wasn’t actually, does that make sense, I was more frustrated again.

Lisa Hendrickson-Jack: So you were upset that you were still upset about it because you wanted to get over it, you wanted to not feel that way anymore.

Samantha Kellgren: Right, right, so I think that once you are at that point, that is when you’re much more easily going to be able to change, but now you’re acknowledging it, now you’re catching it before you just were thinking it and it was just allowed to just sit, your mind had these thoughts and it was just allowed to hang out in your head, and now you’re like, wait a minute, I don’t want that thought in my head. Exactly, exactly, and I think some of it for me came from a point of interest of, okay, over and over again, now I’m reading this side of things, now I’m not reading the diet culture-y stuff, now I’m listening to podcasts like this, now I’m reading Nicola’s book, now I’m seeing, oh, I should be able to eat way more, okay, let’s see what happens. And little by little I didn’t change everything in one sweep, it was, I eat non-fat yogurt, okay, I’m going to add whole fat, I’m going to have whole fat now, and that’s what I do, so it was one small change at a time, and seeing that your body does not blow up overnight, it’s really learning to trust, like you said, your body is smarter than you.

Lisa Hendrickson-Jack: Well, so there’s a thing that I want to touch on as well, one of the many issues with having goals about how many calories you’re going to eat a day, in my opinion and experience, is that then you kind of lose, food is just fuel, it’s just something you have to do, it’s not necessarily enjoyable, you’re just consuming food because you have to, and if you’re restricting to a small number of calories each day, it’s very functional, you’re not eating because you love to eat, you’re eating because you have to, am I wrong here?

Samantha Kellgren: And a lot of people get to that, the thing is I liked food and I was cutting myself off from fully enjoying it, I enjoy food, but I would go to a restaurant and try to get the healthiest thing, because it’s not the same.

Lisa Hendrickson-Jack: I guess I don’t want to make broad assumptions, so I’m just sharing some thoughts, and of course feel free to correct me, and I’m not saying this is the way, but obviously your relationship with food is different when you’re looking at it in a certain way, when you’re trying to get a certain number of calories, and I guess what I’m getting at is, if you have this idea that some foods are good and some foods are bad, as opposed to food is food, and some foods are more nutritious or not, but the concept of certain foods being good or bad, there’s just different ways to look at it, I guess I’m saying, but the question out of that is, if you have all these rules in general about exercise, about when you’re eating, about how many calories, then I would imagine that you’re not necessarily looking at food as in the same way as nourishment and really having a full understanding of how to make your body healthy. So even if we take it back to the menstrual cycle, if you want to have a healthy menstrual cycle, you want to be nutrient replete, you want to make sure that you’re getting the macros, protein, fat, and carbohydrates, because you need fat, I’ll say animal fat, I’ll say cholesterol, and I understand that everyone has opinions about that, but I’m saying that we make estrogen, testosterone, progesterone, cortisol, and vitamin D from cholesterol, and cholesterol comes from animal fat. So for example, if eating fat is a problem for you, then again, there’s got to be some education there about, if you want to have a healthy cycle, if you want to bring your ovulation back, if you want to have sufficient estrogen to build your uterine lining and sufficient progesterone to prepare it for pregnancy, so that everything is good, then you’ve got to have some fat so that you can make those hormones, for example. And even looking beyond calories, what foods are nutrient-dense, but again, I’m just curious of your thoughts, because I’ve interviewed different women regarding HA, and one of the challenges is that anything that encourages any type of food restriction or any type of food categorization as good or bad can then wind up catering to these not so healthy tendencies, what are your thoughts on that?

Samantha Kellgren: I agree, I mean, I feel like anytime you’re labeling things of this is good and bad, and there are more nutritious, less nutritious, that’s a thing, but when you label it as off-limits, and I’m sticking to this diet, that is when you see those restrictions come in, and that’s when it, that’s when you instantly think of, I shouldn’t have this, I should eat this versus what I want, and that’s when you tune out of your hunger cues, because you’re going on, this is what I should have, I’m ignoring what I want.

Lisa Hendrickson-Jack: Well, and what are your thoughts on, because I’m pretty sure I had this conversation with Nicola, or she talks about it in her book, the idea of eating ice cream and chips on purpose, so that you can try to let that go, because of course for some people it’s like, oh my gosh, that’s so high carb, or so high sugar, we could talk all day about this concept, but no, I mean, I always say to my clients the goal isn’t to live this weird kind of quote unquote perfect life where you never have ice cream, so what are your thoughts on that, because I certainly understand the idea behind it, that if you’ve been restricted to the point that you never quote unquote allow yourself to eat any quote off-limit foods, then that’s a problem, and so sometimes you might have to eat the ice cream in order to help you get over that, but I’m not sure what your thoughts are, I’m not saying go eat ice cream, but I’m just exploring this idea.

Samantha Kellgren: I don’t think there’s anything wrong with you eating ice cream if you want to have ice cream, I don’t eat ice cream, but I feel like from what you’re saying we’re on the same page, because what it is, making sure that it’s not from a fearful point, that if you have this your day isn’t earned and you didn’t do anything bad. Of course I’m not going to say yes you need to eat all cakes and doughnuts and ice cream, it’s more the mindset behind it, it’s more that knowing it’s okay if I have this, that is not a big deal, and not overthinking it, do I want some ice cream, okay, I’m going to have some ice cream, instead of this all or nothing of I never have ice cream, or I have the entire carton of ice cream every night because I can have ice cream, it is, do I feel like ice cream today, and normalizing that, normalizing having what your off-limit foods were and realizing there are no off-limit foods, so I feel like it’s more the mindset of, can I have this and not feel guilty about it, because it’s that guilt that comes afterwards, and then the action that comes after the guilt, the running to work off the ice cream.

Lisa Hendrickson-Jack: Yes, and I feel like tying that exercise to eating, I felt fine going and ordering whatever I wanted when I had a long run, but if I wasn’t doing the long run I would have felt guilty had I done the same thing, and I’ve totally untied those things, and it took work, it took work through, let’s see what it’s like to go out to eat on a weekday when I used to only go out on the weekends, small little changes like that, and practicing them and seeing that it’s not the end of the world, and seeing that your body doesn’t change overnight, that’s where I feel like that practice of having the dessert, of having the ice cream, of having the cookies somewhat regularly, instead of trying to fit it into this is the amount that I can have, let’s see what happens, what happens if I did overeat and I was full, and I had too much and I didn’t restrict the next day, what happens then, and practicing that and getting okay with it so it doesn’t seem like it’s the end of the world.

Lisa Hendrickson-Jack: I mean, I feel like there’s the harm that the diet industry has caused with this idea, basically this idea that we’re like robots or machines, because I feel like that’s what this idea is based on, that it’s really calories in calories out, I can’t tell you how many books I’ve read that just take that kind of stuff for granted, and we’ll just say that, for instance if I’m reading a business book it’ll kind of just equate that with another goal you set, and you just cut out this many calories and then you just do this, and it’s so interesting how it’s just taken for granted that that is how our bodies work, that we’re machines and we need a certain number of calories, and if we want to lose weight we just have to reduce the caloric consumption, because there are plenty of, if we’re talking about different modalities, different alternatives, that don’t require you to lower your overall caloric consumption but simply to shift your macronutrient ratio, for example, so it’s just so interesting how this one thing is so taken for granted, this idea that we’re like robots, machines, and that’s how we need to do, and it’s all about weight, that’s the other thing, it’s all about weight, and so this whole thing is about maintaining a certain size, shape, number, and it’s not about trying to be of optimal health, trying to have great energy, trying to feel vibrant, trying to make sure that your cycles are ovulatory and healthy. So what I would love to see shifted is that conversation around, of course the menstrual cycle, but the menstrual cycle is such a fantastic biomarker that we have as women that we can gauge these things, and so it’s hard, of course, if you’re on the pill, because in your case this issue, you don’t know how long it was going on.

Samantha Kellgren: That’s the thing, I have no idea, it could have been that first marathon I trained for, that could have been like, hey, this is too much, who knows.

Lisa Hendrickson-Jack: Who knows, and I really feel like, but again, that’s an ideal, or you should always be striving to be more lean, well, a fertile body isn’t a lean body, it’s a different, that’s not healthy, it’s an aesthetic goal that does not take into account what a woman’s body needs to function properly, but they ignore all of that, it is only, here is how you can look, it’s not here’s how you can feel, it is here’s this ideal and here’s how you can get there by cutting calories and by eating perfectly clean, and it’s just not, and like you said, it’s not, our cycle is going to tell us that that’s not right, because that is when you see things go completely bonkers, is when you’re not eating enough calories, and it’s just having too much stress going on, and there’s that mental stress of not only the stress from working out, the physical stress, but the stress of I have to get these workouts in, and the stress of the guilt if you quote unquote eat too much, if you go off your eating plan, the stress and guilt that come with that is yet another stress that you’re adding.

Samantha Kellgren: Yeah, no, completely, and I mean, one thing I’ll just say is that not all women with HA are super thin, it can affect women who are not tiny, not underweight, it’s individual, it’s so individual, it’s your, but it was too much for your body.

Lisa Hendrickson-Jack: Yeah, exactly. Well, so as we bring our conversation to a close, one thing that I do want to acknowledge is that some women who struggle with HA, so losing their ovulation and their cycles, do have eating disorders, do find themselves struggling with a more clinical issue, for example, and so in your case it sounds like you were able to do some research and really sort this out little by little on your own, and many women can do that, and so there’s great resources, we talked about, No Period, Now What, Nicola Rinaldi’s book, and we’ll surely link that in the podcast show notes, I always refer women to that book for HA because it is the text, it’s a huge book, and it really provides a lot of great information, so certainly there’s ways for you to start and work through this on your own, but from your experience, what about the women who need some additional support, how do you talk about those types of things, is there a point at which you would recommend for a woman to either seek at least coaching or group support, or actual therapy with a counselor, to help her address some of these body image and eating disorder patterns?

Samantha Kellgren: Yeah, I mean, and once you realize if it is an eating disorder, to get a therapist that specializes in eating disorders, to get you covered there, I feel like coaching helps you stare down that unknown timeline of, I don’t know how long, because this is a recovery phase, it’s not like you can never run again, it’s not like you can’t work out, but in this phase of truly rebuilding, restoring your cycle, it’s a different phase, and you don’t know how long it’s going to last, and that is what I really focus on with my clients, is looking at this is a phase, this is you’ve been missing a period for however long, over-exercising for that section of your life, this is this small section where are we going to rebuild, get your body to trust you, to trust your body, and then you can move on, and then you can add more workouts in if you like, then you can add running in if you like, but it’s going to be from a healthier place. So I feel like coaching comes in handy when you don’t know where to start, when it’s overwhelming, because it is overwhelming to make all these changes when you feel like you’ve lost your identity, it is, where can I start, how can I talk to the people around me so that they are supportive, that’s one thing I help with, is building that support network around you, so you don’t feel like you’re doing it on your own, because we definitely overanalyze and overthink things, and so to stop that spiral, and here are two things that you can work on this week, let’s focus on those, and to break it down and help you with that mindset, because you’re going to doubt it, because it feels so foreign to you to totally change what you were doing, and when you don’t get a period back right away, you think, oh my god, I’m not doing it right, what am I doing, maybe this isn’t worth it, and you’re going to have those spiraling thoughts, so to help keep you in this place of, no, this is what you’re supposed to be doing, this is the right track, let me show you why, let me tell you how I did it and how others did it, to keep you on that track with your sanity.

Lisa Hendrickson-Jack: Yeah, no, thank you for laying that out for us, I think it’s really important to have support, whether it’s a group, an informal Facebook group of women who are also going through HA, so that you have a place to ask questions and get support from people having actual experience with it, if you are ready to make those changes and want that accountability, and then also if there is another aspect of this that goes even deeper, to really know that there are therapists and counselors who specialize in HA, and you’d have to do a little bit of digging to find them, but certainly there are, so that you can really get the support you need, because ultimately everyone’s goals are different, but in my perfect world we’d be healthy, we’d have access to information about our cycles, we would understand that there is such a thing as a normal cycle, and if your cycle is not normal or not happening, that is an indication of an underlying health issue, not an unexplained phenomenon that we have no idea about, the world would be so different if we just had access to this information, and if we were to look at our bodies as not broken, but as essentially perfect, and I know that might sound strange, but your body was created perfectly in my belief system, and so when there’s an issue, it’s an indication to you that there’s something wrong, and if you sort that out, it goes back to normal functioning, so we have this tendency in our culture to say, oh, my body’s broken, I’m not ovulating, there’s nothing wrong with me, no, your body’s actually functioning normally based on the environment it is in, it is responding to that environment by doing these things, and so if you change the environment, change the habit, change the exercise, change the eating, change the support system around you, change your Instagram feed, then so much can change, and it’s not because your body was broken, it’s literally because your body is just responding to this now healthier environment that you’ve created for it, we just need to trust it, and you need to trust it, and it will trust you.

Samantha Kellgren: I feel like that’s the biggest thing, is that it knows what it’s doing, you can’t outsmart it.

Lisa Hendrickson-Jack: Well, thank you so much for being here today, Samantha, this has been such a great conversation, very informative, where can our listeners go to learn more about you and what you do?

Samantha Kellgren: Yeah, well, I’m on Instagram, it’s Simply Well Coaching, no diet culture stuff there, all the stuff we talked about, my website is simplywellcoaching.com, and I do have a Facebook group full of supportive women that help each other out through this, when they’re having doubts they post if they’re having struggles, and we really help support each other through that process of getting their cycles back.

Lisa Hendrickson-Jack: Awesome, well, thank you so much, we will link all of the places that you shared in the show notes for this episode, and so thank you again, this has been a very important and fun but important conversation.

Samantha Kellgren: Yes, well, thank you so much.

Lisa Hendrickson-Jack: Thank you for listening, if you enjoyed today’s show please share with a friend, you’ll find the show notes page over at fertilityfriday.com/349. I hope that you enjoyed today’s episode with Samantha, it was I think really important, eye-opening to go through some of the specifics of her experience with HA and some of the specific challenges that make it difficult for women to overcome, because as I always say, in some ways HA is very straightforward, we know that it happens when women are not consuming enough food to offset their caloric usage, we know how it works and why it works, but dealing with it isn’t always that easy, because there’s a reason why women with HA are depriving themselves of the required nutrition that they need, and I will go ahead and link on the show notes page my previous HA episodes, there’s a couple of episodes with Nicola Rinaldi, author of No Period, Now What, which are excellent resources, and again, in a time where many women don’t actually just get the basic simple explanation from their practitioners of what this is and what you can do about it, when many women are still getting a prescription for the pill instead of an explanation and true intervention and support, these types of interviews and podcasts and books are essential to help women overcome these issues. And when I’m thinking about HA, I look at a lot of things from the perspective and lens of menstrual cycle charting, fertility awareness cycle charting, and what strikes me as really interesting is when you understand that the menstrual cycle is a vital sign, and you understand how the process of charting works and how your cycle reflects your overall health, there couldn’t be a more obvious situation that there is a problem than HA, so we have a reproductive age woman who is not ovulating at all, no period, nothing, and there couldn’t be, from that perspective, anything more obvious that there is a problem, and so that’s one of the reasons why charting should be a central part of healthcare, I mean we’re far from that, very far from that, for it to be a standard part of medical practice, a woman’s charts reviewed in a standardized way, but I think someday we’ll get there, and someday the knowledge and understanding of the menstrual cycle will be a central part of understanding a woman’s overall health, because it’s this important vital sign that is missed. So with that said, I want to thank you for tuning in to today’s episode, I want to thank you for continuing to support the show, and of course as always, until next time, be well and happy charting.