Going DUTCH, Part II
Hormone update. Which I’m writing as much for my own benefit as anyone else’s… because I can sense that I’m finally (FINALLY) making a bit of progress, even if nobody else would necessarily notice it. As ever, the process is slower and more subtle than I’d like, and I’m so anxious to see ‘visible’ training progress that I’m admittedly losing sight of the bigger biological picture. “Slow progress is progress,” and any forward motion at all is actually a BIG DEAL.
Here’s Part I of this story, as well as a menstrual cycle overview (which, just sayin’, is my most popular post ever — *shines fingernails on shirt*). But, in essence: I have likely not been ovulating for close to two years now, meaning my body has been making almost zero progesterone, with abnormally low estrogen as well.
Hormonal wonkiness is pretty common among athletes, and when you train for performance, you (by default) will not be in your most optimal state of health. The effects crept up slowly, and I ‘compensated’ well enough that it took a long time for me to reach a breaking point. But this has been going on for long enough now that the imbalances are legitimately limiting my ability to make progress, so they’ve got to be addressed.
The above post was written in July, but unfortunately, none of the changes that I discussed there seemed to make any discernible difference. My cycles continued to be a consistent 21-22 days in length, and the periods themselves actually became progressively more painful, to the point of nausea, lightheadedness, and cramps waking me up from sleep multiple times a night. Each month was worse than the last; there were several instances where I literally couldn’t stand upright in the kitchen for the two minutes it took to microwave my heating pad. (At work, I would lie down on the floor of the clinic in between patients.) The acne on my chin (a sign of ‘estrogen dominance’ / excess estrogen relative to progesterone) was horrifyingly bad, and I’d also picked up 5-6 pounds around my middle despite consistent nutrition and food tracking.
That’s no way to live. So, about seven weeks ago, I made two big changes: adjusting macros (reducing my inadvertently-excessive intake of protein and instead going up to 400g/day of carbs), and initiating acupuncture / Traditional Chinese Medicine (TCM) treatment.
First, the macro adjustment. There is a considerable dearth of information out there on other training/nutrition-related cycle disturbances besides just amenorrhea, which is really unfortunate. However, I’d seen a few passing references to the fact that insufficient carbs can mess with cycle even if overall calories are appropriate. And while I definitely wasn’t thinking of my former 300g carbs/day as ‘insufficient’, clearly it was, since I ended up inadvertently “filling in the calorie gap” with like 220g of protein (#facepalm). That split definitely didn’t make any sense and is actually kind of embarrassing — I have enough experience with nutrition by now that I should have known better — but also, I can look at RP’s ‘protein-based’ method of counting and kind of understand how I would have unconsciously trended that way over time.
At any rate, better late than never. As of September 28th, we’re now at a (much more appropriate) 400g carbs on training days, with ~160g protein and ~80g fat. (Overall calorie intake hasn’t changed, just the carb proportion — and the scale is totally stable, maybe even a tiny decrease.)
Anecdotally, I’m ‘Instagram friends’ with a masters athlete who had been doing exactly the same thing nutritionally until she was advised to try 400g carbs/day for performance reasons. When I asked her about that, she suddenly remembered that she had also been having a really short cycle, which went back to 28 days with the macro change (!). Here’s hoping that my experience will be similar. I don’t think she’d been ‘in the hole’ for as long as I have, and we know that ovarian follicles take ~100 days (three months) to mature (meaning any given cycle is really more representative of the state the body was in three months prior) — so I need at least another 6-8 weeks to determine whether this change is going to make a dent.
Secondly: acupuncture. Not something I'd ever tried (or, admittedly, ever put much stock in)... but in talking with a coworker who used to live in China, the first thing out of her mouth was a local recommendation for a Traditional Chinese Medicine (TCM) practitioner who had helped her when she was trying to get pregnant. And then (that same week!) I saw a Philadelphia friend give it a try for a musculoskeletal injury, with considerable success... so figured that even if it didn't help me, it was unlikely to hurt.
Let me just say: this stuff is fascinating. (Get this: at my first visit, the practitioner knew what day of my cycle I was on just by feeling my pulse!) Until now, I really thought that a big part of Eastern medicine was probably placebo effect, but I see it differently now. The approach/assessment is so completely different from everything I know that it feels like a new language — but all human languages are equally full and expressive; they just utilize very different mechanisms to accomplish that. Similarly, this style of medicine is a completely different way of viewing/interpreting biological phenomena — more about the ‘energy balance’ of different systems, the amount of heat versus cold, etc. — but that doesn’t necessarily mean that it’s any less detailed or effective than the way Western providers are taught to think and treat. I didn’t fully understand that before.
(To clarify: I’m definitely not opposed to going the Western route with my regular GYN if this doesn’t work, but, as a Western-trained provider myself, I anticipate that to initially feel a bit like ‘retracing my steps’. I certainly don’t presume to know everything, but since I couldn’t easily ‘solve the problem’ on my own based on the things I know, it felt more ‘natural’ to me to first try something completely different and test out some territory that I don’t know.)
In Western terms, I’m showing symptoms of ‘estrogen dominance’ / not enough progesterone. The TCM diagnosis is a ‘kidney yin deficiency’. (Most people have heard of ‘yin’ and ‘yang’; yin is the more calming, ‘female’ energy; yang is the more fiery, ‘masculine’ energy. Everyone needs both, but they need to be in a particular balance.) Again, just like with a new language, my brain is constantly looking for ‘anchor points’ with which to start to ‘break the code’; in this case, I’m comparing ‘yin’ to progesterone. Which, on a gut level, makes a lot of sense: progesterone is a ‘slowing’ hormone in almost every way (read my previous post for more on this). As I’ve said — TCM has a different way of conceptualizing the information, but their way of thinking isn’t necessarily any less ‘accurate’.
But honestly, the first acupuncture treatment did not sell me. It was cycle day one, I was super uncomfortable, and (despite what I’d been told to expect) I did not feel relaxed on the table at all and couldn’t wait for it to be over. At the second visit, I reported honestly that I’d felt zero difference — still an awful period, still feeling weirdly bad in the gym. The response (which I think I’m glad I didn’t know at the time) was that if that first pattern of acupuncture needles had been the ‘right’ one for me, I would have felt immediate relief. As in, instantly no more cramps.
My skepticism showed itself here again; I don’t know why I assumed there would be only one way to address an issue. (After all, in Western medicine, if one medication doesn’t work, we try another one.) So he used a completely different approach the second time — low back and posterior scalp, instead of belly and fingers — and that time, I understood what everyone talks about. I felt much more relaxed on the table (my Garmin was solid blue / ‘parasympathetic’ the whole time), and there was an odd sensation of heat being drawn out through my feet. (Anecdotally: the practitioner happened to mention that the ‘kidney meridian’ is also very involved in the ankles/feet… which, given my history of foot issues, is just interesting.) And — I don’t have better words than this — after that second time, I actually did ‘feel different’, like something had shifted somehow.
Beyond acupuncture, the other mainstay of TCM treatment is individualized herbal blends. At first, mine was 10 different powdered ingredients that I had to stir into hot water and drink; during my third visit, I was told that I was “going to be a difficult case, due to the degree of deficiency,” and the herbal intervention was changed to pills, with a total of 23 different ingredients. I’ve looked them all up, and most of them are just various plants and roots, but there are also a few weird ones: turtle shell, deerhorn glue, and praying mantis eggs (!). Oddly, the pills actually smell delicious to me, much better than the powder did; it’s an ‘earthy’ aroma that’s hard to identify, but is weirdly appealing.
My first full cycle with both of the above interventions was still just 22 days long, but at the seven-week mark, here are a few positive things to report:
My sleep is changing. I never saw sleep as a major issue, since I’ve never had trouble getting 7-8 hours, but I have consistently woken up at 2:00 every night for the past couple years. In recent weeks, though, that wakeup time has shifted to 4:00am (much more convenient, since there are days when that’s the time that I need to be up anyway!), and after a bathroom trip, I can usually go back to sleep for another 2-3 hours. This means I get a bit more sleep overall, and (in Western terms) also seems to suggest a cortisol reduction, since that’s usually what drives 2:00 wakeups.
The horrible chin acne (a specific sign of estrogen dominance) is finally slowing down — it’s definitely not gone, but it’s starting to get noticeably milder.
With this most recent period, the symptoms were somewhat better — still very painful, but the misery didn’t last quite as long and wasn’t accompanied by nausea or lightheadedness this time.
It was both encouraging and heartbreaking to have a brief blip early in this current cycle — days 4 and 5, to be precise — where I suddenly felt absolutely amazing. Happy, hopeful, positive, entirely ‘myself’. I hadn’t felt that good in a really, really long time, and it was terribly disappointing to wake up on day 6 and realize that (whatever it was) was gone, and I was back to feeling ‘flat’. But, again — slow progress is progress. Getting that little ‘taste’ reminded me of what’s possible and why I’m investing so much time and patience (and money!) into this process.
The above often feel like laughingly small things compared to how desperately I want to see some performance improvements. I’m also eager to ‘earn the right’ to do a short cut and get back to that place of ‘relaxed confidence’ inside my body. But objectively, I know that this ‘project’ has to precede all of that. With as often as they’re blamed for things, hormones have become almost a cliché — but they’re also legitimately powerful. Even though it wasn’t entirely deliberate, I’ve been (as my bodywork therapist likes to say) “taking the batteries out of the smoke alarm” for a long time now — and we’re at a point where I have to acknowledge and address the underlying problem first in order to ultimately move forward in any kind of effective way. I’ve accepted that, even if I still have days where I have a hard time giving myself grace about it.
In essence, what I’ve had here is a little ‘preview’ of menopause, and gotta say, I am not a fan. I’ll obviously accept it when the time comes, because there won’t be a choice — but no need to rush Father Time. Right now, there is a choice. And around here, we play the long game. Healthier hormones and bones and brains right now means more potential athletic progress six months from now — and fewer potential health problems twenty years from now.
One day at a time. I’m writing this on cycle day 17, and I go back for a fourth acupuncture treatment on day 21 — we’ll see if I can scrape an extra day or two (who knows, maybe a twenty-THREE-day cycle this time?). Objectively, though, it’s likely to take until the first week of January for me to see/feel the progress from everything I’m doing right now. (Because — returning to Western medicine for a moment — women make progesterone via ovulation, and it takes three months for eggs to fully mature.) So there may well not be any difference in cycle length this time — but even if there’s not, it still doesn’t mean we’re on the wrong track.
In the words of a pediatric surgeon I used to work with: “Time, nature, and patience.” We’ll get there.