Jul 22, 2015 5 min read

Q.I was anorexic for nearly four years. I’ve been in recovery for almost six months. It’s been really hard. At times I still hate the way I look. I’m getting healthier. It’s slow and difficult. I have a few questions. When do you think I’ll get my period back? Before I got sick I had just started it, like maybe for a few cycles, but I haven’t had one for almost three years. Why is that? Also, could I get pregnant now even if I’m not having my periods? I’m not having sex right now. I don’t think I’m ready. I feel pretty messed up most days. I just want to know if I change my mind. Finally, how do I tell people? I’m moving to a new school in the fall. Eating with others is tough for me. I feel like people just watch and judge, no matter if I eat or don’t eat. I’d like to explain, but not to people I don’t trust. Thank you for being there.

17-year-old

Mary Jo’s response: Anorexia can be life-threatening. I’m pleased you’re in recovery; in a very real way your courage is saving your life.

You don’t mention your current treatment. I hope you continue to see a therapist. People living with anorexia need long-term support and an individualized treatment plan. Often a multi-disciplinary approach (treatment involving more than one type of health-care provider) is best. You may see a counselor or psychotherapist regularly, meet with a social worker who can help you deal with stress, and consult with a nutritionist to assist with food intake. Your medical doctor or nurse practitioner should monitor your health; a gynecologist can answer your questions about your reproductive health. You’re worth the effort it takes to stay healthy. You’re not alone. Family and friends can benefit from support groups – their presence in your life is important.

Too often we act as though mental-health issues can improve without treatment, or with a brief visit to a counselor. Living with anorexia for four years is not quickly overcome. Please continue to care for yourself. Some wonderful online sites offer support: Information at http://www.womenshealth.gov/publications/our-publications/fact-sheet/anorexia-nervosa.html can answer questions and help guide your treatment. The National Eating Disorder Association provides peer support. Their stories of hope (http://www.nationaleatingdisorders.org/stories-of-hope) can make your recovery less challenging.

A woman’s period often stops with extreme weight loss. In fact, the absence of periods for three months is one of the symptoms of an eating disorder like anorexia. Menstrual cycles are affected by the amount of fat/muscle in a woman’s body; hormones change with extreme exercise or erratic eating, causing secondary amenorrhea (loss of periods for six months or longer). During anorexia, stress hormones like cortisol increase and the chemical leptin lowers (leptin is necessary for ovulation – the release of an egg). When a woman’s treatment helps increase her weight and her eating returns to a healthy pattern, her hormones regain balance and her periods resume.

Some women in recovery return to their typical menstrual pattern in a few cycles, while other women take longer, even a year or more. Many people believe a woman with amenorrhea (no menstrual periods) cannot get pregnant. Amenorrhea typically is linked to ovulation suspension. Without the release of an egg a woman cannot make a baby. However, each woman’s response to recovery is individual. I suggest a visit to your health-care provider. Blood work and a physical exam can help you understand your fertility.

You’re wise to be sensitive to your emotional state when considering a relationship and sex. You’re vulnerable – making healthy choices can be challenging when a person is dealing with stress. Even though your menstrual cycles haven’t resumed, I suggest using prevention if you do become sexually involved. Once again, your health-care provider can help you.

I asked our peer educators to help me respond to your questions about starting a new school and sharing with friends. I agree with their response. If good friends and your family are aware of your situation, they can ease your stress and help you throughout your treatment.

I think you should feel proud of the way you’re continuing treatment and seeking help. You matter. You’re an amazing person of great worth. Please stay in touch.

Peer Educator response: We believe that most people will like and accept you. Part of anorexia is feeling like others judge you, even though they don’t. Honestly, you shouldn’t need to tell other people about it if you don’t want to, and you shouldn’t if you don’t trust them. Your mental health is your own business. However, if you want to talk to someone you trust about it, we’re sure they’ll accept you. Just be truthful about it. They’re likely going to ask questions. If you’re in recovery, be sure to find friends who will support you. We think you should do what makes you feel happy about who you are.

Have a question? Send it to Dr. Mary Jo Podgurski’s email at podmj@healthyteens.com.