Hormone Imbalances and Missing Periods: What Midlife Women Need to Know for Lasting Health

Natalie Tysdal (01:23)

Danny, good to have you on the show today.

Dani (01:25)

Thank you for having me. I'm really excited to be in this audience we talked earlier. You're thinking your audience is more like 40 and up. And I am so excited to be in front of an audience of that demographic. So thank you and thank you for having a show that does that and the work that you do.

Natalie Tysdal (01:42)

Well,

this is a, it's a really important topic because we think of our periods as kind of a nuisance until we start to want children. And then when we children, it's a necessary part of that process, but it all has to do with a much bigger system of our hormones. So I know this is your passion. Tell me how you got into it and how you help people.

Dani (02:05)

Yes, thank you. So I got into it because I had this problem. So I was well into fitness like many other women around 18. I just started going hard on exercise and diet. And I got really into sport and became a competitive weightlifter and just felt like I always needed to lose weight and I always needed to like look just as fit and strong as I was. So...

I went down to, you know, calorie tracking, macro tracking, paleo, did most of the diets, you know, that you can think of whilst doing a lot of exercise at the same time. And pretty early on, exactly when, I don't know, but pretty early on, I completely lost my period. Like, they're just, it just stopped coming. And I intuitively knew it was because I was exercising and dieting a lot. Like I wasn't...

Natalie Tysdal (03:03)

Probably like, well, hey, this is okay. A lot less trouble, right? That's what a lot of, a lot of, especially young women, they don't want the nuisance of it. So, hey, that's fine, I skipped a month. Is that what you were thinking?

Dani (03:04)

confused.

Yeah.

Yeah, I skipped a month and then I skipped like seven years, you know, like before, you know, and, you know, I.

Natalie Tysdal (03:19)

Ugh.

without any, without

even a trace of your period and you didn't worry about that?

Dani (03:28)

had no idea. Right, so was like 18 through to, you know, my mid-20s when I just assumed that, you know, I think a lot of people think this, that your menstrual cycle is like an optional extra that's just for having babies. And that wasn't on my radar. And I also felt like it meant that I was working out hard enough and it was kind of a badge of honor for me.

Natalie Tysdal (03:43)

Hmm. Yeah. And it sounds like, yeah, that's what I was just thinking

is you wore it as a badge. Like I'm working out so hard, I don't get a period.

Dani (03:53)

Mm-hmm.

I was, I was proud of it. I was actually proud of it. Like in hindsight, I can still feel like, remember how I felt about it. And it wasn't until I went to an annual like women's wellness checkup with a new OBGYN that I had never been to that they asked me about my periods. And I was like, I don't have them, you know, like good for me. I'm just something delusional, which just goes to show you how much education there is on this growing up, right?

Natalie Tysdal (03:58)

Yeah.

Dani (04:26)

And he told me, well, we worry about that. So yeah, like a male OB-GYN gifted me with the information that my period was important. And he prescribed me progesterone, which I know now, you know, just triggers a bleed. But actually I also know now had I taken it, nothing would have happened because there was no nothing to bleed out anyway. So I, I wore this like fitness.

personality as a badge of honor too, right? So of course I'm not going to solve my problem with medication. You know, I'm going to go out there. I'm going to find the solution. So as soon as I knew it was actually had longer health term health consequences, I was on board with fixing it. I just really went a long time having no idea that it mattered to produce hormones and to have a cycle.

So went down a rabbit hole and came across what is the diagnosis, which is hypothylamic amenorrhea. And I just found this through Google rabbit hole. There is not a lot of information about it. Like it's relatively unknown, which is crazy because it's not a syndrome or a disease or a disorder. It's just kind of like menopause. It's like a natural process that happens at a certain point. And for this point, it happens when not enough raw energy, like food.

coming into your system. It's kind of logical. The body would shut down systems that are not required for survival right now. And so that's what it did. And I had to get it back online. The problem is how you get it back. As someone who really wanted to diet and exercise and was like, this is what I do and this is how I find value and this is how I'm worthy and this is how I'm going to get.

opportunities in the world by being this pretty girl, right? Like that was how it had to be. I was hearing that I needed to stop doing those things. Like how I need to eat food. I need to eat real food, not diet food, calories, actual nutrition. And I needed to stop exercising my face off, you know, five, six, seven days a week.

And it turns out that was really, really difficult. And it was a whole like life altering identity crisis that I went through. But I went through it. I chipped away with trials and tribulations and setbacks and relapses. And I got to the other side and I had gained a lot of weight.

you know, relatively, like to me, I had gained a lot of weight.

Natalie Tysdal (07:12)

When you say a lot,

like how much did you gain?

Dani (07:16)

like 30 pounds, like 30 pounds. When I got my period back and I went through the process of trying to keep it, which is a whole other thing. And when I got on the other side, you know, I realized that was really hard and I was all by myself and it was really difficult to find resources and information. ⁓ And so that's when I decided to create that. And so I went and created a podcast.

Natalie Tysdal (07:18)

but you got your period back.

Dani (07:45)

which led to creating a community, which led to going back to school to learn all of this stuff for myself, which led to working directly with women with this very, very specific issue. So we're like a, I now have a clinic, we're a team of five, well, like an online clinic. That's a team of five and we just help women who have lost their periods, get their periods back ⁓ half the time to get pregnant and the other half because they realize the long-term.

Detriments.

Natalie Tysdal (08:17)

So, wow, ⁓ I'm curious about the long-term consequences of what you put your body through. Are there any, or can you just get back on track, now you're getting your period and your hormones are leveled out and things are okay?

Dani (08:32)

There's long-term consequences to being in AJ, right? So if you never get your period back, osteopenia, osteoporosis, we're even seeing research come out about brain health, which makes sense, right? The female body is so estrogen dependent and that you have none. So actually in women, estrogen is connected to everything. It's connected to everything.

Natalie Tysdal (08:59)

Yeah. Yeah.

Dani (09:02)

Chronically depleting that long enough will have long-term effects. The beautiful thing is though if you do reverse out of it, I had it like seven years and I am Perfectly fine. You would have no idea there. There was no long term. I've had a baby the whole shebang ⁓ It's fully reversible this is in the literature Ha feed yourself get your period back start ovulating. That's the really important part and then

you can you can restore bone health. I mean obviously at a to a certain degree depends on the level of severity. You can restore your bone health, restore your hormones, your egg reserves usually solid, pregnancy, birth outcomes, miscarriage outcomes are no different in women who have had HA than they are in women who have not. So it appears that it's a fully reversible thing and I think that that is because

This is a bodily function. Like the body is designed to shut it down when necessary and designed to turn it back on.

Natalie Tysdal (10:08)

Just how common is it?

Dani (10:11)

So it's estimated to be about 16 million worldwide. ⁓ But it's an estimate because it's very hot. You we don't really ask it in like the census, but it is estimated to be 16 million worldwide. I believe most women are like on the spectrum.

Natalie Tysdal (10:26)

But I imagine most of the women,

yes, most of the women I imagine who are dealing with this, they have no idea like you what it is. They probably don't put a name to it. They don't think it's a problem. It's just something that happens.

Dani (10:46)

Yes, and it's also masked by birth control. If you're on birth control, there's a solid chance you can continue cycling. Some people will still lose their menstrual cycle on birth control. But you know, as we know, most women are on it, you know, during their reproductive years. And it's not till they come off of it that they realize something is awry. I happened to never have been on it. So I knew what was happening from the beginning.

but a lot of women chalk it up to the pill and they'll mention it to their practitioner who will also chalk it up to the pill. So they kind of live just with no idea of it until they're trying to get pregnant. And so they never find out.

Natalie Tysdal (11:30)

Let's draw this back to just irregular periods. Maybe it's not the seven year stint, but I know now this has led you to a career in this and helping women who are just irregular. A lot of young women, a lot of our daughters who are dealing with, just skipped a month. wait, maybe I skipped two months. Like they don't even know, but it's irregular enough. How do you help people with that? And why is that a concern?

And I think for a lot of them, know having college-aged daughters, I was just really stressed that month.

Dani (12:02)

You're spot on, right? It's a spectrum. And a lot of women who get full on missing periods are grateful because it's such a loud, clear alarm bell that is like pretty black and white. But when you are on the spectrum and you have enough hormonal activity to continue to bleed, continue to ovulate, it can be harder to get your diagnosis. It feels a little bit more like... ⁓

vague, it could be so many different things, it could be normal, this is just me. But we do see women with short luteal phases, so they don't produce enough progesterone in the luteal phase, which more women get diagnosed with early onset menopause than they do with hypothalamic amenorrhea, when what they're actually experiencing is, you know, low hormone function, but practitioners will tell them like you're in menopause at the age of 30.

You know, and this is just not likely and this tends to be what happens. So we will get women who are having really long cycles, you know, every two, three months apart. So they're being told they have PCOS and they, because that's kind of what happens with PCOS. But as they dive further down their rabbit hole, they're like, this doesn't really look like PCOS. Let me keep searching. Then they find us. Then there's confusion. Well, I'm not missing my period, but it's not PCOS.

You know, this is something that happens, but we take them through the exact same program, you know, once they're on board. And you'll also see women with, yeah, like periods that are like 18, 25 days apart. It's happening really quickly. It's kind of all over the place how it can look, ⁓ but certainly it's showing up in that way. And it's just that they happen to have just enough hormonal activity to get something to happen.

that actually just creates like more confusion.

Natalie Tysdal (13:59)

Yeah. So you mentioned HP, PCOS. What are some of the other common issues going on?

Dani (14:08)

When it's not AJ, like what else are we seeing?

Natalie Tysdal (14:10)

Yes, HA.

Yes, when it's not HA, PCOS, what are some of the other things?

Dani (14:16)

On honestly rare occasion, there's premature ovarian insufficiency. The thing is with all of these issues, it's actually not hard to differentiate when you know what you're looking at, right? Like PCOS, high LH. POI, high FSH. HA, low everything. You know, like this isn't, and then you can kind of like interview someone on the aspects of their life. What is their relationship with health and exercise?

because we actually never see HA in someone who doesn't have a history of diet and exercise. It just doesn't happen. So like these people are easy to pick out, right? And then there's the nuance of having both HA and PCOS at the same time, which is possible, often because the protocol for managing PCOS puts people in HA, you know, if they do a really good job.

of diet and exercise control to manage PCOS, you can now end up on the opposite side of the spectrum having to reverse out of AHA so that you can go back to managing PCOS. It's like a whole thing, but those are the main three we see. There's not really any other issues coming up at the moment ⁓ that are confusing people with this issue.

Natalie Tysdal (15:35)

Well,

so let's talk about the medical world then, because for most women, they're going to see, hopefully, they're going to be seeing either their primary care or they're going to an OB-GYN and getting ⁓ their wellness exam, ⁓ all of that. But what's your frustration with that? Why is that broken or is it broken?

Dani (15:57)

Hmm. You know, my frustration with it is a couple of things. One that people go to medical professionals and we, we've really put them in a position that I don't know if they even want to be in where we're like, ask your medical professional about everything. Where at the end of the day, their scope of practice is medicine. And if you go to a doctor, they think you want medicine.

Like that's not their fault. Like that's how they were coached. That's how they were taught. That's what they went to school for. ⁓ And they just like aren't really in the business of giving you holistic natural advice. I think we all kind of know that, right? But we're told to go and do that. So women have this issue and their very first line of defense is actually, when you think about it, a pretty dramatic line of defense.

Let's go straight to a medical practitioner to fix this problem with a pill that we actually don't have, you know? And so they also get angry later on when they find out they have HAA. They get angry that their doctor didn't tell them. Now I do think doctors should understand this basic anatomy. This is kind of basic stuff, right? Don't eat enough, can't menstruate. But they don't know that. And so they recommend like...

them to go on the pill or just take progesterone. They think it's a fix. It's not a fix. So that's a frustration for me. It's like they're not trained in it, but everyone is trained to go straight to their doctor for this issue that actually just requires you to take a chill pill, not a medical pill. So that's the first one, I think. ⁓ And then the second one is probably like,

Natalie Tysdal (17:37)

Yeah.

Dani (17:48)

the way that women are really being told that this is.

Like you're gonna have to get IVF. Like you're just, you're gonna have to. Just straight out the gate. And what's even worse about that, because we get a lot of women who have already done that before they, you know, finally find us because the IVF doesn't work. When you have HA, there are very few instances I know of where it's worked.

Most of the time, your hormones are so low that you don't even have the baseline foundations needed for a procedure like IVF2 work. So women are spending a lot of time, money, emotional and physical heartache and pain on something that they never needed to do.

Natalie Tysdal (18:42)

Yeah. Yeah.

Yeah. And they just, didn't know. I mean, you mentioned like, you know, if there's anything broken to me in the medical world, it is not just giving a pill, but asking the right questions. Like if someone asks, how many calories do you eat a day? Is that question asked to be able to get the diagnosis?

Dani (19:06)

Never. never, like, there have been some women who were like, I had an amazing OB who understood and knew what to do. I mean, mine always got there, you know? But for the most part, that's what's happening.

Natalie Tysdal (19:07)

Yeah.

Sure, there are some great ones.

Yeah. So how do you help people? What is that? What does the process look like if someone is coming to you? Like, I'm just not getting a period or I'm skipping periods. ⁓ is it a hormone balance that you're trying to help them find?

Dani (19:37)

Yeah, so we're trying to arouse hormones from slumber, first of all, right? So the hypothalamus has shut down this process. It's just gone like, no, but it's always sending pulses through the body looking for opportunity because it wants to ovulate. It doesn't want to quit, right? So it's sending pulses through, we have what we need? Yes, no, yes, no. So the first thing we do is help women introduce enough food that...

the brain can start to pick up on that signal. And we track the progress of this using the fertility awareness method. So that's counterintuitive to people, like how can you track a cycle that you don't have? But actually, you know, all of these women are just stuck in a really long follicular phase. Like I was in a seven year follicular phase, just kind of laying dormant, right? And so we're tracking that and watching them go from...

low baseline temperatures, right? A woman should be around 97.4 degrees Fahrenheit and above, but women with HA are like 97, 97.1, 96.9. So there's our first piece of evidence that estrogen is low and metabolism is shot. So let's start making changes and watch how that evolves on the chart. And now, we didn't produce cervical mucus for years.

but now we're seeing cervical mucus come out of our cervix. Like this is information. This is proof that a follicle is now starting to mature on your ovary. let, you know, let's keep going. So we're giving them that hormonal feedback in correlation with the diet and lifestyle changes that they're making. Cause that's the hardest thing. Women say, I will go down this route, but I need to know that it's working because I ain't gaining weight for no reason.

Right? That's the culture we're in. So I try to create all of these pieces of evidence that give them confidence that they're doing the right thing for their body and their body is responding. Because the truth is it can take like three months to get that first cycle back. Cycles need cycles to keep rolling. And so if you're starting from a dead stop, this takes work. It takes a therapeutic dose of food to tell your body and remind your body what to do with it.

And from there we get a cycle on the board and then we can start looking at other things like pregnancy, ovulation, luteal phase, defects, like parameters like that. But yeah, it's really, it's a lot of emotional work too. women fear food, they fear weight gain. So this is something that is technically a simple solution, but a very emotionally complex one.

Natalie Tysdal (22:26)

Yeah, must be. That's a really big deal in the weight. And then when hormones are coming back, just our natural ⁓ emotions that come along with the cycle.

Dani (22:38)

Yes, because when you have HA, you're actually very emotionally stable person. ⁓ Which is interesting. You're always very flat. However, you are extremely irritable. You don't like spontaneous. You don't like the plans to change. You're very neurotic. Those things pick up. But for the most part, you're not like crying all the time or feeling like just the, you know, the waves that come with being a woman. That part's gone. And then it comes back. But ⁓

Right when a client is like angry and ready to fire us, we know that's the moment they're actually about to get their first period.

Natalie Tysdal (23:15)

You're

like, hey, you're angry. This is great. Congratulations.

Dani (23:18)

Yeah, we're like, you're full on irrational and

like you're you think your life is over. That sounds about right.

Natalie Tysdal (23:25)

Yeah, we need to embrace all those emotions. I always tell my girls that and young women, I'm like, it's wonderful that you feel, I know it doesn't feel like it, but it's so good that you're emotional right now. It means your body's working.

Dani (23:40)

Yeah, what a trip.

Natalie Tysdal (23:42)

Yeah. Do you do blood work along the way or how is it that you are able to, um, to help women engage their progress?

Dani (23:51)

Yeah. Blood work, especially at the beginning, we always want to check rule out things like we mentioned to like, want to rule out POI. I want to rule out PCOS. I wanted 100 % rule in HA. So in the very beginning, we are looking at reproductive hormones, estrogen, LH, FSH, prolactin primarily. Then, on occasion, you know, but with the chart, like I mentioned, the chart shows you what you need to know. If you have a beautiful looking chart,

where your follicular phase is within range and then you're clearly ovulating, your temperature rises and your luteal phase is clearly beautiful. Like I know what your estrogen and progesterone are doing. I can see that. So I don't usually need to. We only use the lab work to troubleshoot. If something is not looking like it should, it's not making sense, you're not following the usual trajectory of someone recovering their cycle, then we'll go and order more labs.

Natalie Tysdal (24:51)

Yeah, well, it's fascinating to me and I'm glad to learn more about it. I know there are people out there who either irregular, not sure why, or they know someone or they have a daughter who might be that way. it's amazing how, and I think it says a lot when you go through something, how it ends up being a way to help people later in life.

Dani (25:13)

Totally. And we even have a certification now that other girls take. So far only women have taken it. know, one day it's not, they don't have to be female, but a certification that people can take to become coaches and do this work or integrate it into their existing, you know, wellness practice. Because unsurprisingly, many of our clients are dietitians and personal trainers and things like that. Right. And so they take this certification because it was so

massively impactful on their life and their perspective that they continue this work. So there's something about it that's very ⁓ innately female. Like I think we, when we realize that as women, we've been being tricked into like suppression and we're being like, we've been convinced to like work hard to be small and work hard to like shut our stuff down.

and you realize what's going on around you and other women are helping you through this and helping you embrace your body and let it be what it wants to be, you suddenly have this like innate pool to like spread the word to other women. And I think that's really cool.

Natalie Tysdal (26:23)

Yes, yes,

it's a beautiful thing. Yeah. And I love it that you have a community because in any hardships that we have, having a community of people who are going through the same thing is so, so helpful.

Dani (26:40)

necessary. It's like one of the biggest issues and the one of the biggest things that women attribute it to. They'll always be like, I could not have done this without all of you guys. Because you just, it's so hard to do something like this alone. It's really scary.

Natalie Tysdal (26:50)

Yeah. Yeah.

Yeah. Well, thank you for the information and for what you do. ⁓ Give us your information and I'll be sure and put it in the show notes for anyone who wants to reach out to you.

Dani (27:07)

Yes guys, come check it out. The Hypothalamic Amenorrhea podcast is actually the best place to start because stories ⁓ and people just sharing their own experiences is the best way for you to learn. But the hasociety.com will send you in the best place for you, whether it's YouTube, podcasts, social media, articles, blog, you know, we have it all in there. I've made sure that there is a way for everyone's learning style.

to be addressed. that's the best place to go just to learn the basics of the subject and then you can deep dive however you prefer.

Natalie Tysdal (27:48)

All right, Danny, thank you. It's great to meet you.

Dani (27:51)

Yeah, you too. Thank you so much.