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It’s hardly the sort of advice you expect to get from a physician: eat more, exercise less.
But that’s precisely what Cynthia Donovan’s doctor told her she must do if she were to stand any chance of having the baby for which she and her husband of four years longed.
Now 39, Donovan is one of 1.62 million women in America affected by Functional Hypothalamic Amenorrhea (FHA).
The condition, characterized by a cessation of periods, can cause long-term health problems including cardiovascular issues, loss of bone density which, at its worst, can develop into osteoporosis and infertility.
And as Donovan learned that day in 2015, it can be brought on by too much exercise, inadequate nutrition and psychological stress – or, in her case, preparing for a wedding.
She tells the Daily Mail: ‘I’d always been fit and healthy, but my desire to have the perfect body tripled from the moment I got engaged.
‘I couldn’t stop thinking, “My big day is coming up, so I’ve got to look my absolute best for the photographs which will be part of my life forever.”’
Donovan was thrilled when her boyfriend proposed in May 2010. She was 25 years old and had just completed her master’s degree in science and nutrition at SUNY, Oneonta in upstate New York. It seemed like the perfect time to settle down.
The ceremony was set for September 2011. Donovan had 16 months to reach her goal of wearing a size two gown.
She went from being an average gym goer who worked out three to four times a week to exercising up to three hours every day.
She would complete two work outs in the morning and one at night, with a particular emphasis on cardio.
As for food, she bulked up her meals with vegetables and seriously restricted her intake of even lean proteins such as chicken and fish and sources of ‘good fats’ like olive oil, avocado and nuts.
She counted calories obsessively, limiting herself to just 1,500 a day – significantly less than the recommended 2,000 for a woman of her five-foot-one frame.
Meanwhile, as she fixated on her appearance, she ignored what her body was telling her about her underlying health.
Her periods stopped, but she simply assumed this was the temporary legacy of years spent on the birth control pill which she had only recently stopped taking.
The wedding in September 2011 was, Donovan says, ‘magical’ though in retrospect she feels a tinge of regret at how much she lost herself to what she now deems ‘societal pressure’ to look good.
She and her new husband had discussed wanting kids before getting married and took for granted that they would start having a family before Donovan hit 30.
‘It was always on the agenda for us, but we thought we’d wait a few years to enjoy married life together,’ she says.
But, despite leaving the stress of the wedding behind, Donovan’s periods did not return.
And, as the months passed, it went from being something she had dismissed without a second thought to a pressing concern.
She consulted her gynecologist, but was told not to worry.
She attributed it to the fact that Donovan had recently stopped taking the pill and told her that post-pill amenorrhea (the absence of menstruation) is common, and can last for three to six months.
But Donovan wasn’t convinced. She sought a second and third opinion.
A specialist diagnosed her with polycystic ovarian syndrome (PCOS), a hormonal disorder that affects fertility characterized by infrequent or prolonged menstrual cycles.
She was prescribed Metformin, a common medication for the PCOS, underwent hormonal therapies, got acupuncture and took dietary supplements.
But nothing worked.
‘It was so frustrating because nobody could get to the bottom of what was going on,’ Donovan says.
‘I was a wreck because I kept saying [to my husband], “What if we can’t have a baby together?” or “We love each other, yet we might never be parents.’
But her husband was supportive and said that, if it came to it, they would try fertility treatment.
Finally, in early 2015, her gynecologist referred her to a reproductive endocrinologist – a specialist in conditions relating to reproduction and hormone imbalances.
He performed a battery of tests and told her the problem was not polycystic ovaries. She was suffering from Functional Hypothalamic Amenorrhea (FHA).
The brain, specifically the hypothalamus, is responsible for regulating ovulation and menstruation. Not enough healthy fats, low body weight and excessive exercise can all contribute to a disruption of this cycle.
The specialist suggested Donovan ate more calories and scaled down her exercise regimen if she wanted to become pregnant.
She recalls: ‘It was hard to hear at first, but it showed that nutrition isn’t as black or white as some people think.’
She followed his advice, reducing the amount she exercised to three sessions a week and quitting her CrossFit gym membership altogether.
She focused on gentler exercise such as yoga, stretching and walking.
She cultivated a more relaxed attitude to food, eating an ice cream sundae if she wanted one and bulking up her meals with grains such as quinoa, drizzled in olive oil, instead of just vegetables.
But Donovan’s is a cautionary tale, because, while FHA is both treatable and preventable, in her case her period still didn’t return within a time frame with which she was comfortable.
She turned to a fertility clinic and hormonal treatment to stimulate ovulation.
After three failed cycles of intra-uterine insemination (IUI) in December 2015 a fourth was successful and she found out she was pregnant.
Her son, Brian, now eight, was born in August 2016.
‘He was this gift,’ Donovan says. ‘I couldn’t believe I was finally holding this beautiful child in my arms.’
And while some women rush to try and get back into shape post-partum, Donovan made a point of not doing so.
She stuck to her endocrinologist’s advice to take things easy, confident that it would pay off in the long run.
She regained her period naturally in July 2017 – seven years after the onset of her FHA.
Just three months later, she conceived again without any medical intervention. ‘It was as if my body had reset itself,’ she recalls.
Brian’s brother, Brayden, was born in September 2018.
Today Donovan doesn’t recognize the woman she was on her wedding day.
She says: ‘When I go through the photographs, I can’t help thinking, “Oh my gosh, that poor girl.”
‘Her focus wasn’t even about the meaning of the wedding, it was about how she was going to look.
‘Yes, I looked great, but was I truly living? Was I truly being healthy?’
Now, she hopes other women will learn from her story.
She says: ‘You don’t have to micromanage everything, especially your body. Otherwise, you might miss out on the most joyous moments of your life.’
She feels so strongly about it, she has made it her business as a certified dietician to help others navigate FHA, its causes and its treatments.
She hosts ‘The Period Recovery Podcast’ and has teamed up with Dr Chrisandra Shufelt, Associate Director of the Mayo clinic’s women’s health research center in Jacksonville, Florida.
According to Dr Shufelt: ‘The menstrual cycle should be considered a vital sign and, if you’re not having a regular period during your reproductive years, it’s a clear indication that something isn’t right.’
But she offers encouraging news, saying, ‘You just need to identify the underlying cause, whether it’s stress, over-exercise or under-eating or a combination. It is treatable and preventable.’
