Jill is an ultrarunner, blogger and youtuber with a simple dream of seeing a world in which all female athletes have a regular menstrual cycle. She shares this dream, as well as her own journey of amenorrhea recovery on her blog, A Case of the Jills.
I recently blogged about taking months off of running, changing my mental and physical relationship with food and amenorrhea recovery here, and the response I’ve gotten is that many female athletes have a similar story.
Jill’s platform touches on so many topics for runners that are universally experienced and almost universally undiscussed, like dealing with weight gain, the reluctance to cut back/stop exercising, overtraining syndrome, body image and more.
Runners don’t talk about the obsession with running, we talk about our dedication. We don’t allow ourselves rest, because that would imply laziness. And even in the face of so much evidence that undereating, overtraining and maintaining a low body weight will inevitably/undoubtedly cause health issues in the present and future; we persist.
Which is why I love Jill’s honest, open and extremely helpful videos and posts. She shares the story of running too much and convincing herself she didn’t need carbs to fuel her training. She also explains the all too familiar experience of asking for help and trying to get answers from doctors, only to receive some shoulder shrugs and vague responses about taking birth control or gaining weight.
Navigating amenorrhea recovery is different for every female because it’s caused by so many different factors of stress, genetics, hormones, training, eating, and body weight. Not everyone will have to totally give up exercise and gain 30 lbs. Some people definitely will. Recovery is about learning to prioritize health and get away from the obsession with aesthetics and as Jill would say, “pulling your head out of your butt”… Ok, so here it goes!
Amenorrhea Recovery with A Case of the Jills
You have a great platform that educates women on recovering from amenorrhea. Can you briefly say what your goals are with your Youtube and blog and how you got started?
When I first started on this journey, I felt that I needed some kind of creative outlet and opened an Instagram account. I never imagined the response I would get! I began to feel limited by the tiny space in the caption. The more I researched and studied, the more I wanted to do more than just vent into cyberspace. I wanted to interact with women in a more impactful way.
The YouTube channel was started as a way to share what I was learning and talk about the things that I didn’t see anyone else talking about. Everywhere I looked, I saw taboos and silence. People seemed ashamed to be open about their struggles and their questions. My main goal is to let others know that they are not alone, then they have to learn that shame is useless.
How long did you deal with amenorrhea without thinking it was a serious issue? Or did you know it was a serious issue, but choose not to make a change anyway?
I am sure that no one will believe that I spent the majority of the 4.5 years that I didn’t have a period thinking that it was no big deal. I chalked it up to my Celiac Disease or hypothyroidism (I take Synthroid) and kept going. When I finally took my head out of my butt and realized that I had put myself into this situation and had the power to get out…that’s when everything changed.
What were some of the answers you got from doctors about your amenorrhea before you knew how to fix it?
When I expressed my concerns, doctors always asked me if I wanted to have children. I would say “no” and they would tell me that I didn’t need to worry unless I changed my mind. Many offered Provera or birth control pills. It shocks me that in this day and age doctors are still trying to tell women that BCP “jumpstarts hormones”. One of the last doctors I saw tested my hormones because at that point I had convinced myself that I wasn’t getting a period due to perimenopause.
I was absolutely not in perimenopause, but I also wasn’t making any estrogen. She said “You’re a skinny runner, so what do you expect? By the way, you’ll be at risk for cardiac events without estrogen production, so don’t eat red meat.” Um, thanks.
Did you know of long-term effects of amenorrhea at the time?
Beyond the risk of stress fractures, I had no idea what the consequences were.
What made you decide to make a change?
As the years went by, I was training more and more and the physical stress was becoming unbearable. I did not know it at the time, but I was also dealing with the onset of Overtraining Syndrome. The weight fluctuations, leg pain, insomnia, blood sugar problems, night sweats, and body swelling due to the obscene amount of stress hormones that were surging in my body were a nightmare.
I remember there was one frigid morning when I was sitting in the car with my boyfriend preparing to go do one of our last training runs for a marathon. I was feeling along my legs and crying because they were so swollen. I broke down and said to him, “I can’t take this anymore. I need to stop. I need rest. And I want my period back.”
Probably typical of most endurance athletes, I had to hit my absolute breaking point before I was motivated to make a change. Sadly, it was less about an actively logical thought process and more from having absolutely no choice but to pick up the pieces of my broken body and try to put them back together again. I am not proud of this.
What changes did you make and how long did it take you to get a menstrual cycle back?
Once I finally understood the problem, I did tons of research on what was going on physiologically and what needed to be done to address it. I completely revamped my diet to add more starchy carbohydrates and increased calories overall. I decreased my running about 80% from peak mileage.
I did not stop running at this time, but I wish I did. (I did stop eventually, but not before again having to hit another wall physically.) I took care to get more sleep, was more diligent about meditating everyday, and generally tried to decrease stress. It took me about two months to get my period back.
How did you deal with doing less exercise and gaining weight?
This is another question that would take an entire novel to answer! Since the symptoms from OTS were so bad, it was not hard to physically stop running. Of course, I still had to deal with the mental complications of not “feeling like a runner” and wondering if I would ever run again.
I did put a lot of unnecessary stress on myself by thinking that I would have to say goodbye to running forever. This was way too dramatic, but very typical of my black-and-white thought process at the time.
Gaining weight was hard for a million reasons. An important one was that I had used my small size as identity for so long in order to combat my underlying feelings of insecurity. I never thought I was special or good enough. Since my body size was something identified as “enviable” by our society, I decided that was the best thing about me. It was hard, therefore, to let go of the thing that I thought made me special.
Oddly enough, the more ate and began to nourish my brain and body, the less afraid I became of the changes. I was feeling so much better that it was hard to remember why I would voluntarily put myself through that kind of suffering.
Have you been able to reintroduce exercise/running back without losing your cycle again?
Yes, I have been able to reintroduce running without losing my cycle, but not without struggling with the consequences of surging stress hormones. I actually came back to running ultras about six months after stopping running completely. I assumed that I was ready and rested, but the inevitable stress from training left me with a lengthened cycle and painful periods, plus my old friends, body swelling and blood sugar crashes, came to visit.
Some of these symptoms are suggestive of estrogen dominance which can occur when the body produces a lot of stress hormones. Again, the physical suffering became unbearable and I finally had to ask myself, “Is this worth it?” The answer was “No”.
I do run now, but no more than 20-25 miles per week. I walk quite a bit and also go to yoga. This seems to be the sweet spot for me at the moment, as I am able to keep this up, recover well, and not experience any awful symptoms.
Do you think amenorrhea poses a serious issue for young female athletes? Why?
Hell yes, it does! There are many health issues associated with not getting a period that are often overlooked by young women. Typically, they are more enamored of the perceived benefits like built-in birth control and not dealing with bleeding every month.
Let’s not forget to mention that losing a period can be seen as quite the victory for the young woman who erroneously believes this condition to be positively associated with peak athletic performance.
Not getting a period is also positively associated with the increased chance of Coronary Artery Disease, impaired cognitive function, stress fractures, osteopenia, and osteoporosis.
There are so many other problems that women will experience when their energy intake does not meet their energy expenditure like gastrointestinal/digestion problems, more colds/flu, mood problems, depression, and more.
Above all, a young runner should be aware of the fact that any improvements in performance due to weight loss will be temporary. No body, no matter what we may think, can continue to thrive when it is so compromised that it fails to perform one if its most basic functions; menstruation.
How can we help to education women on the importance of maintaining good hormonal health while training?
We can help to educate women of all ages by removing all of the taboos or shameful associations with this topic and continuing to speak loudly. We have to encourage athletes, coaches, and parents to not shy away from exploring absolutely every facet of amenorrhea, from the physical to the emotional.
We can only fully understand how important this is by removing any stigmas, which are nothing but obfuscation.
We can also demand more of our healthcare practitioners by sharing our concerns with them. I know that many of us have been disappointed in our interactions with doctors, but we must not mistrust them or think that they are trying to mislead us. There are many reasons why physicians are simply not trained to recognize this problem in our very niche population. That doesn’t mean that this can’t change.
It’s my dream to come up with a way of opening up the dialogue between patient and physician that extends all the way from pediatrics up through primary care and OBGYN. No female should ever be told that not getting a period is “no big deal”.
Anything else you’d like to share with female athletes who are navigating how to get a menstrual cycle back without giving up doing what they love?
The way to get a menstrual cycle back without permanently having to give up what what we love is to not be held back by fear. Fear is what drives women to refuse to give up training in the short term, thereby ruining their chances of getting back in the long term.
Fear is what convinces women that they can not let go of their habits of overexercising, underfueling, and avoiding foods that cause anxiety. Fear is what tells women that their world will come crashing down if they gain weight.
I know women reading this are saying, “But, it’s not that easy.” You’re right! But, I was the WORST. I feared everything, denied everything, refused everything. If I can do this, anyone can…I promise.