Dealing with PCOS & FHA: My Experience
I’m sharing a bit about my experiences with PCOS and FHA. These are just my own experiences and do not serve as any recommendation of how to treat your own issues. I wanted to share this because I found a fundamental lack of resources about these conditions for female strength athletes.
This is going to be a long one, so grab a coffee and settle in.
For the past 4-5 months, I’ve been dealing with a host of hormonal issues that have thrown me for a serious loop. In order to discuss what I’ve been doing to heal those issues and make progress with them, we have to back up to where this all started.
After Nationals in October, I was in pretty bad shape. I had been competing hard all year, dieting hard for a good bit of my season, and most importantly, I had been neglecting some very critical self care. I was working A LOT, sleeping very little, and was overall extremely stressed out on a daily basis. I am normally a person who can handle hard training and caloric restriction pretty well if I am taking care of my recovery and stress levels. When I don’t….I crash and burn. And that’s exactly what I did over the winter. I had lost my period for a few months and didn’t even really realize it until it returned on Thanksgiving. I was constantly freezing cold, my hair was extremely brittle and breaking, I was so fatigued that I could hardly function, my skin was a wreck, and my anxiety was so out of control that some days it was nearly impossible to leave my apartment. I took a trip to my gynecologist, we ran some tests, and she referred me out to an endocrinologist, initially to test my thyroid. After explaining everything to my endocrinologist, we had a few ideas of what could be going on and I was sent in for blood draws (so many) and a glucose tolerance test (aka chug this disgusting sugar drink and sit around for 3 hours). About a week later, my doctor called me to give me the results. All of my thyroid horomones and hashimoto's indicators were completely normal. But, my testosterone levels were extremely high and my glucose tolerance test had started out picture perfect but there was a slight abnormality with my response towards the end of the test. Towards the end of the test, I felt pretty damn bad due to the fact that I don’t chug sugar on an empty stomach very often. The high testosterone + slightly abnormal glucose response + missed periods + other symptoms lead to the dual diagnosis of: PCOS and functional hypothalamic amenorrhea (FHA).
Let’s take a little break to discuss what those two things are:
PCOS = polycystic ovary syndrome; an endocrine disorder in women characterized by cystic ovaries, hormonal disruptions, insulin issues, and other hormonal and metabolic issues. See this page for a great overview.
FHA = functional hypothalamic amenorrhea; Secondary amenorrhea or absence of menses that can be caused by inadequate nutrition (calories or specific macronutrient groups), weight loss or low body fat, or overload of stressors. It can be caused by a combination by any or all of the above as well. Some women have cycles but they are abnormal and not “true” cycles (like me!).
My endocrinologist explained everything to me and noted that she was a bit unsure of what course of action we should take because she couldn’t give me the standard recommendation of “eat better and exercise more”. She admitted that she had consulted several of her colleagues when coming up with a treatment plan because female strength athletes are not a population they frequently see. We wanted to take a systematic approach to treatment and decided to start with medication. We agreed to try a medication (Metformin), and then have me experiment on my end with training volumes and dietary things and see how that went. I picked up my metformin and took it for a whopping 7 days before I couldn’t handle it - I was getting extreme hypoglycemic episodes on the very lowest dose. At one point, after training, I had to stop and pull over on the side of the freeway to be sick and try not to pass out because my sugar had crashed so hard. My doctor took me off of that and we agreed to have me try some stuff on my end, monitor things closely, and come back in about 3 months for a follow up.
I began to furiously research anything and everything regarding PCOS and FHA. It was absolutely infuriating to say the least. First, I could barely find any information at all on “lean” PCOS (the category I fell into) in general or any information that did not revolve around getting pregnant (because that must be a woman’s ultimate goal, right? *eyeroll*). Second, any information I did find was inundated with what I call, “woo” aka bullshit science. Don’t get me wrong, there are ABSOLUTELY things outside of the traditional medical realm that work wonders for so many people, myself included. However, it is a complete disservice, and quite predatory, to assume that because women are struggling with things that science doesn’t have a great grasp on, they automatically deserve (aka are so desperate) to be fed bullshit that is quite clearly not rooted in any actual science. I digress, as that’s a whole different topic for another day. Third, I felt like I couldn’t find any information for someone in a similar position as myself - someone who trains (and specifically lifts), already eats well, and already has hormonal birth control (IUD). Suffice it to say, nothing was very helpful. In short, there was virtually no information on how to deal with these things for the female strength athlete.
I felt very lost and angry and frustrated. I felt so out of control and out of touch with my body and that feeling was so very foreign. I struggled with feeling like I lost a big part of myself. I identify myself very closely with my athletic endeavors and with being a person who troubleshoots and solves problems. And here I was, not doing any of those things. I really struggled with the fact that I had, somewhere along the way, fucked up. I knew deep down that I had messed up by stressing so much and putting my recovery on the back burner. High stress and low sleep are big triggers for me and add in getting glutened several times over the holidays, and it all added up to my body being overwhelmed (and rightfully so) with stressors.
After a brief pity party (because I’m a human being and this shit sucks), I decided to do what I do best: look at data and make a plan. I examined several different data points that I routinely note such as my diet, my training, my sleep, my cycle, etc. I started to do some research and investigating into my own data and experience to come up with some potential approaches that centered around carb manipulation and not losing weight. That last one was/is tough - I had gained some much needed weight back after my season, which was my goal, but it came on rapidly and basically wouldn’t stop. I don’t particularly care about the scale when I don’t need to make weight for a competition, but my body felt pretty bad and I wasn’t happy with my physique. A brief stint of some lower calories after I had been eating at maintenance for awhile indicated that my body wasn’t down with dropping weight. More details on all of that later. I decided to get with my diet coach (S/O to Anthony at Complete Human Performance for his endless patience with me) and come up with some dietary strategies for us to try to see what worked. Both my diet coach and my doctor agreed that an overall low carb strategy was NOT the best approach, so we got creative and decided to try an aggressive carb cycling strategy (details of that later).
Beyond things like diet and stress reduction, I wanted to examine other ways to help ameliorate these issues. However, I wasn’t down with loading up on supplements with little scientific backing.I didn’t want to spend a small fortune on stuff that may or may not work and I don’t have the time to implement a very complex supplement routine. That’s just not my thing, personally. I stuck with my usual items for the most part so that I could evaluate what made a difference if my next round of blood tests came back differently.
On the exercise front, my endocrinologist also encouraged me to NOT stop training all together - she knew that I’m a competitive athlete and training is part of my life and since my cardio is pretty low, she encouraged me to monitor my training and cycles and work my coach to make adjustments from there. If I needed to stop training for a bit, that would be a bridge that we would cross when we got there, and that currently is not the case.
Fast forward to today...it’s about 4 months later and my testosterone has dropped 50 points back into the normal range, my cycle is getting somewhat regular, my weight has stabilized, my physique is in a place that I like, and I feel about 100 times better. I truly cannot express enough gratitude towards my diet coach, my coach, and my endocrinologist for helping me find what works for me at this moment.
So what exactly did I do to help heal my PCOS & FHA? That’s coming up in the next post...
P.S. There is a new episode of "The Article We Were Too Lazy to Write" up! This one is on the importance of words, language, self talk, and related topics!