How do you get your period back?

A Registered Sports Dietician discusses how to recover from amenorrhea

It is all too common for young women to lose their period with run training, which has been normalized and even glamorized in running culture.

So how does a runner restore their period once it’s lost?

It’s a simple question with a complex answer. One that Heidi Strickler can help with.

As a Registered Sports Dietician, Strickler helps female-bodied athletes restore their periods.

“I have increased my focus to working with female athletes who are struggling with disordered eating, amenorrhea, and (Relative Energy Deficiency in Sport) REDs,” Strickler said.

Low energy availability is at the center of REDs. When a runner burns more energy than they have, their body goes into low power mode. An unfortunate cascade of health and performance consequences follow, including secondary amenorrhea (losing the menstrual cycle for > 3 months). Amenorrhea is destructive to many body systems, including cardiovascular function and bone health.

Strickler helps young runners understand their cycles, nutrition, training and how it all comes together.

Her treatments can include meal planning, journaling, identifying fear foods and food roles, creating ‘challenge meals’, and completing workbooks dealing with body issues.

She also provides athletes with education around the nutrition needs of a growing female runner; creating dialogue around body image and relationships to food and exercise, and establishing support from safe friends, family members, and mentors.

She also collaborates with mental health therapists, doctors, coaches, parents, and other members of the athlete’s support system. 

While reaching out for professional help with disordered eating can seem daunting, Strickler says most of her young female runner clients initiate treatment themselves. But the process takes dedication.

“They realize ‘what I’m doing to my body is actually not great.’ When we get into the nitty gritty it gets really uncomfortable,” Strickler said. “It’s me continuing to support them and understand it’s not a linear process. You need to also reiterate the benefits and remind them of their long term goals, because it gets harder before it gets easier. It is very much a therapist role in addition to a dietician.”

Part of Strickler’s process is to first establish the severity of a client’s energy deficit. Then she creates a safe plan of care to increase energy availability. She will monitor overall health as well as the return of a client’s period.

“It is a combination of eating more and/or reducing exercise plus managing stress,” Strickler said. ”From an eating more standpoint, it is super important to eat complete and adequate meals and snacks every 2-4 hours. (The runner) definitely needs to be eating before and after exercise.”

The timeframe of period recovery varies. Sometimes a young woman’s period returns rather quickly and sometimes it takes a year with the help of medication to jump start the ovulation process.

Strickler doesn’t consider a young woman recovered from amenorrhea until she’s had 6 consistent periods. A normal period is a cycle from 24-35 days and the cycle-to-cycle variation is less than 9 days. The period should be 3-9 days, Strickler explained. 

Working with female athletes who are struggling with body image and disordered eating is personal for Strickler. As a collegiate soccer player turned collegiate track athlete, Strickler developed disordered eating habits.

“I never had a coach or medical professional who connected the dots of my low heart rate, low BMI, and no period,” Strickler said. “I was just this ‘fit’ runner.

“I hate how common it still is for struggling athletes to get swept under the rug and even called ‘healthy’ because of society’s idea of what it means to ‘look like a runner.’”

After college, Strickler started running ultra running. Her disordered eating progressed to an eating disorder.

“I got swept up in clean eating and my disordered eating ebbed and flowed for 10 years,” Strickler said. “I also felt pressure as an RD to ‘walk the talk.’ I ended up suffering a bone stress injury. I had a DEXA and found that was I was almost osteoporotic. By the time I admitted myself to treatment at Opal Food & Body Wisdom, in Seattle, the doctors told me I could have died in my sleep. Which is terrifying, because I was running 80 mile weeks.”

Strickler was initially hesitant to go public with her eating disorder story. As an RD, she is supposed to be the one with the answers. But, as life often proves, there are answers and relatable experiences on the other side of struggle.

She now uses her experience and passion to operate her private practice, Heidi Strickler Sports & Performance Nutrition, LLC. Strickler’s business is primarily virtual, which allows her to reach young women all around the world. 

“I’m very honest in sharing my own stories and experiences in going through the process to help them understand they are not alone and it gets better; reminding them of why we’re doing what we’re doing,” she said.

To book a session with Strickler, find her on Instagram at hkstrickler_sportsrd.

Katie Noble is a Doctor of Physical Therapy, a journalist, and a runner. She enjoys empowering and supporting female runners with evidenced-based education.