I want to preface this by saying that not everyone with anorexia will lose their period.
It is not a requirement of diagnosis anymore and hasn’t been for some time, and it isn’t an indicator of how unwell you are. Some people lose their period at a healthy weight, and others don’t lose it even at very low BMI’s. But as someone who has had missing periods for very long lengths of time and then very irregular periods, I want to take some time to discuss how it feels to both lose it, and get it back.
Despite the disclaimer above, I have been happy every time I have lost my period. It has always been something my anorexia could congratulate me over, and a marker that I was doing what it wanted and being successful at being thin and unwell, regardless of what my rational brain told me about it. I tend to have very little interest in my physical health during the times when I am most unwell, because nothing is as important to me as weight loss. I also always have seen myself as immune to the dangerous side effects of anorexia despite learning over time that that isn’t true. Additionally, I am not especially interested at this stage in my life about pregnancy so it didn’t matter to me that my fertility could be impacted.
It’s important to note however that it’s not only fertility that is affected by not having regular periods. Those hormones are also vital for bone health, which is why not having one puts people at much higher risk of osteopenia or osteoporosis. That said, as somebody with clear DEXA scans, that also wasn’t something that felt relevant to me, despite how at risk I have been on paper.
For many people, the return of periods is something they strive for. It’s associated with reaching a positive stage of recovery, and for people who want children it is a huge motivator to stay well. It can be a relief when you’ve not had one for a long time and you want to fall pregnant, and something that should be celebrated. Lots of people also associate it with their womanhood and femininity, which can be a really important part of somebodies identity.
I don’t disagree with any of this because I can understand why people feel this way, but I feel like it’s the only narrative that exists and that isn’t my experience of it all. I was devastated when mine returned. Especially because most recently they came back at a relatively low BMI still, and a lower one than I lost them at. I was taken by complete surprise by it, and it felt like my bodies way of telling me I could stop. I didn’t need to gain any more weight because my body had decided it was healthy enough to dedicate extra energy to hormone production. My treatment team were reassuring but I still in hindsight don’t think enough time was spent discussing it with me, because to them it was a positive thing. It was a marker that I was heading in the right direction.
I was also very frustrated with how many people automatically congratulated me on it because “at least it’s more likely you can be a mum now!” That’s not a priority for me at all, and I felt annoyed that I was being reduced to that based on my ability to have periods, when actually my goals for recovery were around my education, career, social life and travel. Children were nothing to do with it and I was frustrated that everybody around me assumed they were because was a woman in my late 20’s. Nobody stopped to ask me if that was something that was important to me, it was just assumed that it was.
I started my periods when I was around 11 and developed an eating disorder when I was 12-13ish. I have never, in my entire life, had a regular cycle due to experiencing so many weight fluctuations as a result of multiple relapses. It has only been since I’ve allowed myself to gain over the minimum healthy BMI that I’ve had consistent monthly periods, which has been for probably around a year now. It’s less distressing for me now that I know when to expect it, because I always felt like every few weeks I was waiting for it to appear to remind me that actually, I wasn’t sick. I didn’t have an eating disorder because no matter how many weeks apart they were, they were still happening. It’s an unpleasant way to live.
There are many reasons people don’t celebrate the return of their period. For trans people they can be tied to really distressing gender dysphoria. For people with menstrual disorders they can come with high levels of pain and discomfort. For people like me, they are a painful reminder that I am distancing myself further from my eating disorder than I’ve ever been and it’s frightening to me.
Everyone’s relationship with their period and their eating disorder is personal, and it shouldn’t be assumed by anybody, especially eating disorder services, that its return is something to be celebrated.