F.E.A.S.T's Around The Dinner Table forum

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bakeyser
Hi,
We are about a year and a half removed from the nightmare of the initial stages of refeeding.  Our D has put some good weight back on, looks healthy, is tall and slender naturally, but at least on charts, as far as normal body mass for a 5 foot 7 inch 15 year old girl.  
We are wondering, how long does it take to get her period back, she had just started it prior to AN.  
Also, are there any suggestions of anything we can try in order to speed the process up?  Supplements or medications?
We had her blood work tested recently, and she is in the normal range for hormone levels, but on the lower end of the spectrum.
We truly appreciate any help and insight.   

Thanks,
B
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scaredmom
Nice to hear from you, bakeyser.
Wonderful to hear  about the weight gain.
the thing about the periods is that she may need more weight. 
Is she on her historical weight curve and not just ‘normal’ weight? Many have had to go much higher in weight to see all bodily and brain functions improve. We need to get them to their specific weight and sometimes. that is an unknown when we start. 
My d was always quite lean and we did not have proper growth charts from age five on  but she was at the 25 percentile back then. For us to see her get her better , she is to get to 40th percentile for weight and now at over 50th she is sooo much better.
I guess when you say hormones there is a range and maybe her cycles are imminent, There are other measurements that can be done too like a bone age, or pelvic ultrasound and endometrial thickness, but either way she may still need to gain weight or they will come ‘soon’, I would think?
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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tina72
Here it helped to check the Leptin level and add more fats then (because body fat was too low for periods) and to check ferritin (iron). This was too low also and she got supplements and periods came back about 2 months later.

Magnesium and zinc are also needed for hormon production in the body. Zinc promotes ovulation by nourishing the follicles in your ovaries. It also supports healthy thyroid function, which is essential for healthy menstruation and fertility. So maybe worth a check if there is a zinc deficiency (which many AN patients have).

It is also possible that she is not back to a good weight for her body. At age 15 they still need to gain to develop a female body.
Keep feeding. There is light at the end of the tunnel.
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scaredmom
Bakeyser,
You asked about any supplements to speed this along, I really don’t think there is tbh.
It really is a matter of time.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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tina72
Is she exercising a lot? Exercising can also be cause of no periods.
Does she suffer from low bone density?
Keep feeding. There is light at the end of the tunnel.
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Foodsupport_AUS
It can take several months at a good weight for their periods to come back. At the same time there are a few things to take into account. She will need to be back to her highest ever weight plus a bit. She may need to limit or do no sport until her period comes back. That is because activity reduces Leptin levels which in turn decreases the chance of cycling. Higher body fat also helps raise Leptin levels, and getting them high enough is important for those periods to come back. If those things are happening then watching. 
D diagnosed restrictive AN June 2010 age 13.5. Weight restored July 2012. Relapse and now clawing our way back. Treatment: multiple hospitalisations and individual and family therapy.
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debra18
I would say more feeding and fats. You could contact Dr o toole at kartini clinic. She seems to be an expert on this subject.
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bakeyser
Thank you all so much for the replies and great information.  Also for the encouragement.  I do feel that our D needs to gain some more weight and then hopefully her period will come. Thanks again,
B
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roadtorecovery
My oldest daughter is not AN.  She was always at a good weight.  Her periods were always very irregular.  Skipped months at a time etc.  I asked my GYN and had her see the GYN once she turned 18 and was still not regular.  My GYN who is very conservative said it is not a issue if they are not regular until they are 18.  If at 18 they still aren't getting periods etc then some girls need BC pills or other hormone therapy to get their body in gear.  While I know the period is a good indication of health, you can still be very healthy without an eating disorder and not cycling at the age of 15.  
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debra18
I don't think so. And taking hormones to start a period is not a good idea. No periods is a sign that the body is not at a high enough weight or not enough fats to function correctly.
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scaredmom
I think the issue here is irregular cycles which can be normal during the  peri pubertal period,  but the question the original poster  had was SECONDARY amenorrhea so periods absent for a long time with the ED. Those are two distinct issues.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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debra18
That is true scaredmom. There is a difference between someone who always had irregular periods and someone that had regular periods that suddenly stopped or became irregular because of insufficient nutrition. I think obgyns need education in this area. They should not be prescribing hormones if the problem is from ED or insufficient calories and fats.
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roadtorecovery
You misunderstood my post.  This was for my daughter who does NOT have AN. If your 15 year old was not regular in life before ED, it is not concerning if she still isn't cycling again.  Now, if she was like clockwork and then that stopped, there is some concern that she's not weight restored if she's not cycling again.  
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tina72
A healthy young woman without AN can also have too low body fat and then periods are not regular or missing too. If the body does not produce enough leptin and other hormons there can be no regular periods and that has nothing to do with ED then.
I also think that it is no good idea to start periods with hormons, that are no real periods.
Keep feeding. There is light at the end of the tunnel.
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drmuhlheim
Here's a newer article:  https://www.verywellmind.com/hypothalamic-amenorrhea-4687508
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iekb
My daughter is also slim and tall (5'8'' or 173 cm) and lost her period for 18 months. Although her goal weight range is 56-58 kg, she needed to raise her weight to 58.5 kg to gain her period back. We were told she needed to go higher than her goal weight for the period to kick in again. She got it back 8 months ago at 58.5 kg, she is about 56.5 kg now and has her regular period. 
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TouchandGo

iekb wrote:
My daughter is also slim and tall (5'8'' or 173 cm) and lost her period for 18 months. Although her goal weight range is 56-58 kg, she needed to raise her weight to 58.5 kg to gain her period back. We were told she needed to go higher than her goal weight for the period to kick in again. She got it back 8 months ago at 58.5 kg, she is about 56.5 kg now and has her regular period. 


I'm surprised that your D's goal weight range was decided at 56 - 58 kgs. BMI-wise that's only 18.7 - 19.3 and well below where I would think a treatment team would aim for (and I'm not surprised it took gaining to the top of that for her period to kick in). My D is only 161cm (5'3) and they put her goal weight range at 53 - 55 kgs  or 20.4 - 21.2 on the BMI scale. From what our treatment team told us is that they try to get the kids around 20 - 22 so they have a bit of buffer so if/when they relapse it can be caught before they get too underweight.


On the topic at hand, my D hasn't had a period in about 9 months but has just recently had 3 day period. The biggest difference we can see is that we've started up a different brand of iron tablets that also combine vit C with it. Maybe if your D has had some anaemia trying iron tablets or a new brand might help kick start things?

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scaredmom
I just wish to clarify here that iron deficiency does not cause amenorrhea. 
Time , weight gain/ body fat , and exercise are the biggest issues with ED. See Dr Mulheim’s post above.
(Also bear in mind these girls can get pregnant too. The most common reason to have lack of periods is pregnancy overall. But with ED it is likely hypothalamic amenorrhea as long as there is no risk of pregnancy) 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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TouchandGo
@scaredmom Interesting, but it's the only thing I can think of that has changed recently that could have triggered her period. We're not doing too well in the weight department here, so those other factors you mentioned don't seem to have made the change. And there's definitely no risk of pregnancy, even if she was interested in boys I don't think she leaves the house enough to get unlucky. I think it's the added iron but it also could just be random coincidence if I'm being honest.
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scaredmom
TouchandGo, 
i wonder too if it was a coincidence as treatment of heavy periods is not withholding  iron, to slow down the periods. It is due to heavy periods that we get the Iron deficiency. 
But of course it should not hurt if her iron levels are not high( ie some  hereditary illnesses are marked by high iron eg hemachromatosis or iron supplements can make iron deposition greater with certain hemoglobinopathies like thalassemias) But as we are not doctors only your doctor can tell you what the issues are for your d.
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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TouchandGo
@scaredmom My D has struggled a long time with iron deficiencies and it's been pretty bad lately (she got awful bruises on her upper arm from the docs blood pressure cuff last week) so we've been trying to include more iron rich foods in her diet and trying different supplements. Her periods have always been pretty short and light, so I think it's more to do with her eating (or lacktherof) and absorption than anything else. This brand seems to be working well for her and she hasn't been having any side effects so we'll find out in a couple weeks if it has made a good impact on her iron levels. But yes, not a good idea to supplement it if you don't have a deficiency or if your levels are already high, my mother has hemochromatosis so I know a bit about that.
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iekb
Just to respond to TouchandGo about the rather low range for restored weight for my daughter. She is an identical twin, her sister weight is 54.5 kg and she never had an eating disorder. Her dad is tall and slim, I am tall and slim (well, relatively speaking given my age) and my son is tall and slim. So the restored weight range was set using her growth curve and genetics. It may be different for different kids.
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TouchandGo
Ah, that makes sense then. My D was always quite petite but seemed to stay around high 19's and low 20's. Using the historical growth chart and comparison with siblings is great, I've just heard a few horror stories about teams giving way too low goal weights. With my D's history of relapses that's why they probably also pushed for a bit of a buffer. Glad everything is good there, then.
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tina72
TouchandGo wrote:
@scaredmom My D has struggled a long time with iron deficiencies and it's been pretty bad lately (she got awful bruises on her upper arm from the docs blood pressure cuff last week) so we've been trying to include more iron rich foods in her diet and trying different supplements. Her periods have always been pretty short and light, so I think it's more to do with her eating (or lacktherof) and absorption than anything else. This brand seems to be working well for her and she hasn't been having any side effects so we'll find out in a couple weeks if it has made a good impact on her iron levels. But yes, not a good idea to supplement it if you don't have a deficiency or if your levels are already high, my mother has hemochromatosis so I know a bit about that.
 

My d has also a iron deficiency (still adding and it goes very slowly up) and we have also seen periods coming back with higher iron level in blood (ferritin) and I have seen that with 4 other girls in the last year.
Keep feeding. There is light at the end of the tunnel.
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scaredmom
I know many who have not got their periods with iron supplementation. 
I think all cases are unique  and one will never know if they did not take supplement what would happen as you don’t have a control. Ie a proper scientific protocol. Anecdotal evidence is just that, anecdotal. 
When within yourself you find the road, the right road will open.  (Dejan Stojanovic)

Food+more food+time+love+good professional help+ATDT+no exercise+ state not just weight+/- the "right" medicine= healing---> recovery(--->life without ED)
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