Lift The Bar

A while back I popped a poll in the LTB group, keen to hear how many PTs either knew about, or had experience of either Relative Energy Deficiency in Sport (RED-S) or Hypothalamic Amenorrhea (HA).  I had a number of emails from PTs who had either had the condition in the past or had it currently.  I’m not going to go in-depth into medical terms here, but it’s essentially when women don’t have enough energy availability and the key indicator is a loss of their menstrual period.  I’m sure we’ve all heard about bodybuilders who find their period disappears around the time of a competition - well I thought that was really the only group affected.  How wrong I was. I’m going to give a brief account of my experience with RED-S over the past 4 years.  It’s an area that has an increasing amount of new research emerging but I’d have never realised I had it without others sharing their experience of it!

After around 10 years on the combined pill, I decided it was time for a break.  Long story short, after a full year without my period returning and various tests by the GP, they referred me to a gynaecologist.  They did a few more tests on me (checking for PCOS, early menopause, fertility possibilities etc.)  and concluded ‘You’re fine physically/anatomically, you need to go home and gain some fat.’.  Now, I’d like to think I’m quite intelligent and switched on when it comes to my body, my health and women’s health in general.  I think at the back of my mind I always knew my body fat % should be a bit higher.  I foolishly thought everything was fine because I still had a period every month but I wasn’t connecting the dots to realise that I wasn’t having a period each month, I was just having a withdrawal bleed from the pill.

I’d always been skinny, as was everyone else in my family.  I was even bullied in primary school for being skinny and accused of having an eating disorder (kids are mean!).  I would pride myself on how much I could eat, I just never gained any weight.  Fast forward to being a PT, and I’m embarrassed to say it was a bit of a badge of honour. I’ve always been able to gain muscle pretty quickly and having low body fat and good muscle definition almost felt like a part of the uniform.   I now realise that I was over training, under-fueling, and coming off the pill was a bit of a wake up call to realise that it WAS having an effect on my health - I’d just been masking it with the pill.

So, when the gynaecologist told me there was no physical reason for me not to have periods, I started doing my own research.  Unfortunately, the only option the NHS could offer me at that time was to go back on the Pill to give my body the oestrogen it was lacking and protect my bone density for future. I’m stubborn and didn’t want to take this as the only answer to something that was clearly a problem.

Around this time, a few well-known local climbers had come out publicly to share that they had been diagnosed with RED-S.  They were really kind and happy to chat, and recommended some private practitioners to me so, I eventually got my official diagnosis of RED-S through them. They analysed my food diary and upped my calories but it wasn’t until I was eating 3,500kcal per day, and stopped all exercise, that I finally started gaining some body fat.  I know this would sound like the dream to some people, and it’s been an odd journey in deciding how much I share with my fat loss clients!

So, I had my private diagnosis and I continued eating and eating and being as inactive as possible (which coincided with the lockdowns so it was easier than it would have been had I been working on the gym floor for 40-50 hours a week!).  It felt completely counterintuitive to all the health advice I would normally be giving other people, but RED-S can fool you into thinking that you’re super healthy when you’re actually running on empty.  For example, my resting heart rate was around 47bpm.  I thought this was a brilliant sign!  New research has shown that in RED-S the body will do anything to save energy - so your heart actually reduces its resting BPM - my low heart rate wasn’t a sign of being super fit, it was a sign my body was trying to reduce my energy expenditure because I had so little in reserve.

More and more research has come out around this topic so I decided to go back to my GP; I’d initially been referred to a gynaecologist (who did, unknowingly hit the nail on the head to be fair) but in doing my research I realised I should have been referred to an endocrinologist - this is a hormonal issue, not a gynaecological one.  After many more tests, they came to the same conclusion - a diagnosis of HA.  I love the NHS, but there was no question of trying to help me reverse this completely reversible condition - I was offered the pill again, which I refused again, or the option of HRT patches - their main concern was my bone density.  I presented all my evidence to the endocrinologist and made a deal that if they gave me a DEXA scan to check my bone density, and if it showed mine was low, then I would take the HRT.  I was fully confident that after years of strength training, my bone density would be fine.  Unfortunately, I was wrong again.  My hip score is great, but my lumbar spine shows I’m in the osteopenia range.  This was a massive blow! Here I was helping people with their bodies and their health day in and day out, and turns out I’d been doing damage to my own!

So for now, I’m on HRT, which I have to say I feel amazing on.  It’s made a massive difference to my mood, my mental clarity and my energy levels.  I will come off it periodically to check my ‘natural’ hormone levels as the goal is still to recover my hormone levels to where they should be without medication.   But for now, I’m accepting the help because I need to come to terms with the fact I’m maybe not as good at looking after myself as I am other people!

I really hope this has helped some of you to read and the biggest take-home I’ve found from the last few years is this:  I am now a massive advocate of everyone (especially my PT clients and every PT in LTB) looking after themselves and putting themselves first.   Early mornings, late evenings, demanding clients and a pressure to ‘look like a PT’ can take their toll on our bodies!   I now have much better boundaries in place with my PT clients, and a better work-life balance overall because I’ve realised how much I need to look after my physical and mental health.   Medically speaking, our bodies don’t distinguish between physical and mental stress - I’m still piecing together the puzzle for my own health, and I urge everyone else to make sure they’re prioritising themselves first and foremost which might seem really obvious for a group of PTs, but the more people I speak with the more I realise it’s not!

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