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Ask Stefani: PCOS Edition, and Cyber Monday Part II!

December 17, 2012
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Due to a lovely letter and set of questions I received from a reader last week, I have decided to respond to a set of reader questions about anything on a bi-weekly basis.  These questions will also occasionally be devoted specifically to PCOS.   Today is the first of the series, huzzah!

I have also decided to run Cyber Monday back again!  From 9AM EST Monday morning (this December 17) until noon EST (December 18) PCOS Unlocked: The Manual will be available for half off the half off!   How enormously fun. !

How to get the discount:

Go to the PCOS Unlocked page.  Scroll all the way down to the bottom of the page where you can purchase it beneath the title “for discounts.”  Enter “december2012″ into the discount box, and away you go!

 

 

 

And here we go!

 

1) I lost my period at about 8 stone 10 pounds. I am 5’5.

Over the many years I have suffered form HA I regained my period on quite a few occasions – sometimes for a few cycles. Previously it was always at that weight that I regained it – and then, like a fool, I would try to lose a few pounds. However, I stopped getting it at that weight nearly two years ago – and I have since gained more weight (I have been 9 stone for nearly 6 months) and I still don’t have my period back.

Is it possible that every time you have your period, and then lose it, your ‘set weight’ at which you get your period back increases? Or do you think it is more to do with the diet I am currently eating/ have eaten before?

 

In my opinion, the best way to think about amenorrhea is to think of it as an algebra equation.  Remember from the 8th grade chalkboard?

 

 aX + bY + cZ + … = Result

 

Think of X, Y, and Z as variables that affect amenorrhea.  X could be weight status, Y could be phytoestrogen intake, Z could be your stress level… other variables might be genetic predispositions, ovarian health, different hormone levels, how much you exercise, what you eat, your micronutrient levels, your degree of sexual activity, your age, whether or not you’ve born children… everything.

Then a, b, c, the multiplying factors, would be how important each of those factors are, and how strongly they are present in your body at any given point in time.  With an enormous value at b, you may not have any problems at all save for stress.  Or perhaps your stress levels are moderate, but your insulin resistance is moderate, so those two factors coupled together increase your “Result” enough to push it over the edge into amenorrhea.

I find it plausible that as you stress your system more and more, your body requires more and more “help” from other areas in order to have optimal fertility.   This does not mean that your set point is increasing– it may be, but I could not ever say for sure– but it does at least mean certainly that variables and stressors on your body are changing shape.   Diet is certainly important– but that depends entirely upon what you are eating at any given point in time.  Keep the toxins out, eat whole foods, get plenty of calories in all of the macronutrient categories, repeat.

 

2) Coffee. I am loathe to give it up, and I have mensturated in the past whilst drinking. However, I will stop if this is a big issue. I can’t see any reference to coffee in the manual. Do you have an opinion?

 

Excellent question!  I do have an opinion.  I would refer you again to the equation I described above.  You may have menstruated while drinking coffee in the past, but perhaps coffee has always been a stressor on your body and you were just able to overcome it at that point in time.  Now it may be a stressor that your body is not capable of bearing.  I would call this a legitimate concern for women who struggle with stress and adrenal health.  If you think your PCOS problems are related to stress, I would consider cutting the coffee.  Or at least reducing the intake and seeing if it helps.  Coffee has the potential to wreak some very serious havoc on our stress responses (really it prevents the body from calming down) and that can disrupt the HPA (hypothalamic pituitary adrenal) axis.  With a dysfunctioning adrenal gland, the hypothalamus and pituitary glands can go off the rails as well.

That said, some women handle both coffee and stress quite well.  It’s an issue of individuality.  I will say however that I believe it is worthwhile to experiment with removing the coffee, simultaneous with increasing your sleep quality and duration, and doing as much stress reduction as possible.

3)  This question is a bit more random – but one Im really interested in.

I am currently married and met my husband a few years ago. When we first got together I began mensturating regularly, although I had suffered with HA before. I also gained a bit of weight so that I was about 8.5 stone, instead of 8. I mensturated for a few months and then lost a bit of weight and lost my period.   I have experienced periods ONLY after instances in which I was quite happy about and excited with my sexual situation. I would also regain my periods after shortlived affairs during periods where I was single.

I do realise many factors that come into play; when I engaged in happy sexual activity I would often eat heavily the next day. However I have also done this without getting my period back. I also appreciate that it may be that oestrogen levels peal and I, in turn, become more attracted to people when happily sexual.

Have you ever heard of the theory that oestrogen levels are spiked by sexual attraction? I knew a girl with PCOS who didn’t mensturate, but when she started an affair she started to.

I’ve heard rumors of such things before and I like the theory.  A quick (quick!) search through some academic databases hasn’t yielded much, especially because you are asking about sexual attraction rather than sexual activity.

I have heard many anecdotes of women who have regained their periods after beginning to engage in regular sexual activity.  I consider this the best method for correcting hormone imbalances.

What these women have claimed to me is that “you lose it if you don’t use it” — or at least that it is true in their cases.  I haven’t been able to learn much about this scientifically.   I can guess, however, how the hormonal cascade might work — dopamine levels, oxytocin levels, and other happy molecules such as serotonin rise relative to baseline when engaged in sexual activity (perhaps to a degree even when just flirting or snuggling.)  In fact, it has been shown that snuggling has a very real effect on hormone levels: oxytocin is produced while cuddling and is also known in the popular press as the “cuddle hormone.”   So this increase in happiness with a sexual edge may very well be like giving your pituitary gland a hug.

Neurotransmitters such as dopamine and serotonin have not been well studied with regards to PCOS.  It has been proposed however that hormones such as LH rise due to the activity of excitatory neurotransmitters such as dopamine.  It stands to reason that when you are engaged in sexual attraction, flirtation, feelings of comfort, or feelings of excitement, your dopamine and other excitatory neurotransmitter levels increase.  These, in turn, may help boost your pituitary function.

All of which is to say that these things– glands, brains, hormones– are still largely a mystery to us.  If you have found a pattern in your life, I suggest running with it.  Learn from it as much you can, and do your best to achieve that kind of happiness / pleasantness as much as possible.  If it’s good for your heart, chances are quite good that it’s good for your body.  Convincing your body you are in prime reproductive condition via regular sexual engagement doesn’t hurt, ever.

4) Over the past six months I have gained weight, stopped exercising and I think I am eating a very nutrient rich diet. I eat lots and lots of eggs, butter, liver and coconut oil. I also dont think I am very stressed. Since my period has not returned – and I am very light boned anyway – I feel like Im now getting stressed. At what stage might would you recommend going on birth control or HRT to protect bones?

 

That’s definitely something to talk with your doctor about– but I would say when your estrogen levels drop below what is typically established as “healthy” or “dangerous.”  That should be indicated on your blood tests, and OBGYNs generally know boatloads about estrogen and bone health standards.

That said, however, there are a wide variety of factors that go into bone health.  Also, if your estrogen levels are low only for a short period of time, you may want to discuss with your doctor the possibility that you continue to try naturally before working on the estrogen with HRT.   I would not stress about it, personally.  That’s largely because I wouldn’t stress about anything so long as I could avoid stressing.  Also this is a matter of personal opinion and understanding the risks.  What you need to know is that your risk for bone porosity increases as your estrogen levels decrease, but your general health and nutrient status is important, too, and short term fluctuations should be fairly well tolerated by most women.   It is also a risk happily born by some women.  I don’t recommend that, but I’m not recommending anything here.

 

5) The final loaded question, which is about calories.

I know it is a question of food quality and not so much of calories. But, like I said, I think I eat a really high quality diet. At 5’5 how many calories would you shoot for as a baseline? After years of undereating, and then a good few months of stuffing myself I think my leptin receptors might not be working that well. I think my metabolism may also be a bit out of whack so it is harder for me to just leave it to hunger or set weight. I can eat about 1200 calories per day and feel satisfied.

Do you have any very baseline calorie recommendations?

 

It’s interesting that you start with the statement “I know it’s a matter of quality more so than quantity…”  Because while that statement may have serious wisdom in it, calorie intake still is vital for women who are type II — that is, under metabolic stress — PCOS.

I understand your problem in calibrating your hunger and trying to figure out how much you should be eating.  It’s a struggle for anyone who has dealt with dieting, regimented eating, or even mindful eating in the past.  What I would say to you with regard to that is to always err on the side of eating more rather than less, and to never try and “go without” food.  If you think you might want to eat, you should eat.  Period!  :)

1200 is a very serious minimum for a woman who is 5’5 and recovering from an issue like Type II PCOS or Hypothalamic Amenorrhea.  I would shoot for 1500 at minimum, but honestly push something closer to 2000.  The important part is to not just “get by” but rather to be seriously satisfied.

Your metabolism very well may be a bit confused right now.  The way to heal that is to eat as intuitively as possible and continually give it as much fuel as it needs– forever.  Wild swings in under and over eating can cause weight flucutaitons, sure.  A constantly satisfying diet over a long period of time is the only way to assure your body that you are being fed.

You also mentioned a lot of nutrient dense foods, which is awesome.  Be sure that you are including some carbohydrate in there.  Carbohydrate is the most readily available energy source, and it also happens to be crucial for the production of thyroid hormone.  Start with a few pieces of fruit or servings of potato / rice each day and see if that helps you find a bit more balance.

As a quick final note, it is possible that you are finding yourself sated in that fasting sort of way on a ketogenic diet (if you happen to be on one), and therefore severely under-eating how many calories your body truly needs.  I speak with a lot of women who confess to eating very few calories but not feeling hungry on ketogenic diets, and then hating adding carbohydrates in their diet because they feel some hunger again.  That hunger, however, may be an important signal for a woman dealing with type II PCOS / starvation / hypothalamic amenorrhea.   (Honestly I think the claim that carbohydrates beget unreasonable hunger is itself more or less unreasonable, and at the very least a matter of personal context.)  Carbohydrate intake is a touchy issue for many people.  What I prefer to leave the conversation with, therefore, are a) the fact that many traditional cultures eat high percentages of carbohydrate with no apparent health defects relative to lower carbohydrate cultures, and also b) the notion that personal experimentation with our bodies and hearts is the most important thing for our health and happiness.  If you eat carbohydrates and find that your body works better, then they are probably for you.

 

 

I’d also really like to finish with the comment that I am willing to try anything   I listened to your podcast with Diane and Liz and your words about not over emphasising stress/ adrenal fatigue etc – because 75% of it is diet –  made so much sense to me.
I know exactly what you mean when you said you would ‘try anything before gaining weight’ – I used to be exactly like that, but I really am not anymore. Now I’m just confused. To kind of summarise I am now half a stone heavier than the weight Ive mensturated at, doing stuff like drinking coconut mlik from the can and no longer exercising. I don’t think I’m picking at the details any more and I would really just value your opinion so much. I have even considered losing a bit of weight – the healthy way! – and then trying to regain it, just to give my body a bit of a shock. Im worried though that would be just like going backwards.

Uh, right.  Don’t do that.  :)   Give your body some love and patience, and trust your body to heal itself.  Don’t panic about it.  Believe it or not, stress about this, even if it seems like it’s not all that much, really might be a significant factor for your physical health.  The fact that sexual attraction has played a role in your menstruation indicates to me that your HPA axis always benefits from some tender loving care.   Give yourself a few months and eat intuitively– you may drop weight naturally, or not, but I think you should be totally psyched about being 9 stone and 5’5– that’s a SEXY weight!– and see what happens.  Get yourself tested again and see if anything has improved.  If not, perhaps revisiting some tests and issues (such as hypothyroidism?) or vitamin supplements would be important at that point.

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Managing director of Paleo for Women and author of Sexy by Nature.

6 Comments

  1. It was great to come to this site and see these questions, many that I’ve been having. I’m 34 years old, having hormonal issues which my GYN suspects is early menopause. (My FSH wasn’t staggeringly high, but definitely out of normal range and into postmenopausal.) I am just a mess and am worried about so much. I have always been underweight at 5′ 7″, my normal weight is 110 pounds, I’ve gone down to 103 since starting to eat high carb primal. I find it such a tiresome chore to eat, I hate thinking about eating. I’ve never had any eating disorders, just a naturally low appetite and I could easily keep my calorie intake high by eating smallish amounts of junk. Now I’m eating healthy but feel I need to think about food all the time to make sure I get enough calories and, in those times my appetite is low, I hate it and am so envious of people who can skip meals whenever they want.

    This site is one of the few that makes me feel positive. Thanks for making and maintaining it.

  2. I know this isn’t a weight loss or weight anything site, but I’ve been following for awhile now. I’m not having a good time losing weight, and am also 5’5, as the woman asking questions is. However, I am 160.5 ibs on a good day. I carry muscle well, have a solid medium bone structure and have a curvy figure, but wish I could be less fluffy again. I would love to be 135 lbs, let alone 126 lbs (9stone), although for my body that would really not look right. I just don’t know what to do anymore.

  3. It’s so very interesting to read your blog, Stefani. The women you talk to are so different and have such opposite problems than I (and most women I know) do. I’ve been very heavy most of my life, and only managed to get my period back and lose weight after cutting out the carbs. There are times when I want to totally disagree with you on certain points, but then I remember that we’re all different. What’s good for me isn’t always good for the lady that sent you the questions. We all have to remember that.

    I’m glad that there’s someone out there helping women with these problems.

    • Oh, goodness, absolutely! Don’t get me wrong — I think a low carbohydrate diet can be enormously therapeutic. It depends so much on what has happened to our bodies over time. I tend to think of it as different poles — if you’ve been pushing to metabolic derangement and are dealing with insulin resistance, cutting carbs can be a miracle. If you’ve been overexercising and restricting for much of your life, eating carbs can be a godsend. Complicated bodies, we are. :)

  4. Could I have PCOS?

    When I was on my first form of birth control pills for about 8 years, I was often depressed, put on weight, and lost my libito. However I did enjoy having nice skin and regularity associated with my menstral cycle. When I went off these pills, I experienced post-pill amenorrhea for about 9 months, but felt more, “normal” than I had in a long time. I did have acne breakouts on my face and back, but my libido returned and my metabolism increased significantly.

    About a year or so after being off my pills, I went on a different set with a lower estrogen level to combat some of the side effects I experienced on my first pills. Though my libido wasn’t impacted as much on these pills there were still some nasty side effects that got worse over time. The new pills caused me to have anxiety attacks and a decreased ability to handle stressful situations in an effective manner. After two years, it got so bad that I decided to go off these pills as well. My doctor suggested that my estrogen levels were likely too low which was causing many of the issues I was experiencing.

    It’s been about four months since I stopped taking the birth control, and I felt “normal” again within a week or two of going off the pills. Less stress, anxiety, etc. though nothing else in my life had changed. My acne has come back in wicked force, and though my menstral cycle recommenced in short order, it’s still irregular.

    I would like to have the benefit of having nice, clear skin again and some regularity to my cycle with the birth control pills (along wiht the other benefits), but I like feeling of being less emotional and anxious. Should I get tested for PCOS? Are there any risks of not being diagnosed? I don’t know much about it and would like to learn more.

    • There’s not really any risks of not being diagnosed other than infertility. I think it might be helpful to know — but you also of course have the freedom to wait and see if things calm down in your body on their own. Knowledge would help you navigate this landscape. For example, you could consider the drug spironolactone (which I don’t necessarily recommend but has been useful for some women with acne) if your testosterone levels are really high and you’re looking for some help with your acne while you troubleshoot other issues. (Though it seems possible much of your acne is progesterone related, since estrogen and progesterone need to be in balance for clear skin.) It seems to me — at a very far distance — that BCP over time decreased your body’s ability to synthesize estrogen on its own, so now you are trying to help it do so. Natural ways to do so are difficult. They include healing your gut and bolstering gut health, reducing stress, and patience, among other things.

      I hope some of that helps. Email me if you need more specific assistance with your troubleshooting. :)

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