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Unread 09-16-2018, 12:32 PM
mnm54795 mnm54795 is offline
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Join Date: Sep 2018
Posts: 1
Default Energy Availability & Amenorrhea

I recently found this site/Lyle's work through a recommendation in my search to learn more about amenorrhea. I have not had a menstrual cycle for ~3 years and have been working to resolve this for the past ~2. I've heard mixed things from a variety of healthcare practitioners, most of whom did not necessarily have an adequate understanding of the condition (this is not meant to criticize their expertise - I have found that this topic is poorly understood by the medical & nutritional community). Most recently I was told that it was solely a determinant of body fat %. I was always a bit suspicious of this as genetic variability didn't seem to quite explain the fact that many women - notably endurance athletes - are not affected by this yet still maintain quite a low BF%. Though perhaps this is my own bias coming from an endurance background. Anyways, though I have been learning more about energy availability and its role, and I have some questions that I can't seem to find clear answers for.

I know recovering the menstrual cycle entails a positive energy balance above the 30cal/kg LBM threshold, which usually entails gaining weight, but does it make a difference how this weight is gained and how much is gained? For example, does one need to achieve the same BF% held before loss of cycle or is this irrelevant if the total amount of weight gained was equivalent but in a more optimal ratio of LBM:fat mass? There also seems to be ambiguity in the amount of weight that needs to be gained for restoration. If I recall correctly, I believe the men in the Minnesota Starvation Experiment actually did not become hormonally "normal" again until regaining their initial LBM (though this occurred with a higher BF%), which could lead one to hypothesize that LBM restoration perhaps drives hormonal restoration. That is purely me speculating though as I'm not sure that study can even be applied in this scenario.

For context, before losing my cycle, I weighed ~120-125lbs; however, that was with a different body composition and higher BF%. My lowest weight was 98lbs in 2016, and since then I have been working hard to gain weight and restore my cycle as my primary concern is bone density loss. I am currently ~113-115lbs but likely have a lower BF% than when I was at this weight previously as I have been strength training (bodybuilding) and can visually notice a difference. Though I don't actually know what my BF% or LBM is.

Fortunately I have actually had a few cycles thus far: first in July 2017 @110lbs, then not again until April, June, July, and most recently this week (9/11). However, they seem to be a bit more irregular and shorter in duration (usually lasting only 3 days), so I am a bit concerned that there may be a luteal phase defect or that the hormones are not completely restored to normal balance. Ideally I'd like to avoid further weight gain as this has been a pretty stressful experience but also am willing to do so if necessary. Do you have any insight as to whether time is simply the factor in allowing things to normalize or if it's more a matter of continuing to gain weight? I'm unsure at what point everything is considered to be "normal" again and future implications for maintaining this.

Also, are there implications for future body recomposition? I am not a physique competitor, so achieving contest-level leanness is not necessary, but it would be encouraging to know that recomp and fat loss at some level would still be possible without loss of cycle. I understand that a conservative deficit to avoid going under the critical EA threshold and incorporating refeeds are important but am still a bit scared that anecdotally any deficit may still result in cycle loss.

Any knowledge about or insight would be sincerely appreciated!
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Unread 09-16-2018, 04:28 PM
lylemcdonald lylemcdonald is offline
Join Date: Dec 2015
Posts: 1,256

Expect to gain some of both but regaining any lost LBM is critical to avoiding body fat overshoot.

I wrote about this issue extensively in the Women's book.
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