Side Effects

Last week I had to have my bone density checked again (something I do every 2 years), and this week I got the results. They weren’t encouraging. For some reason, I hadn’t made any improvements over the past two years, and I was filled with a sense of deep frustration. I’d been doing everything I was supposed to, after all, but my aggravation really stemmed from the fact that the reason this is an issue at all is because I lost weight.

Now, I know that you’re supposed to consult a doctor before losing weight (or so all the diet commercials tell you), although I’ve always found that a bit difficult to swallow, since most overweight people I know avoid doctors like the plague. Additionally, I’ve never been completely sure what the point of this consultation is. Is it so the doctor can tell you not to go on a grapefruit or starvation diet? Or that you should exercise? Anyway, as you might have guessed, I didn’t do that. At the time, I didn’t even have a doctor in Portland; the closest I had to a doctor at all was the one I saw when I was a kid, back in Casco. I do wonder if some of my unanticipated side effects (like bone density issues) might have been prevented had I followed this suggestion.

Then again, it would likely depend on the doctor. For instance, I doubt anyone would have told me at the beginning that losing weight might give me knee problems. I’d heard the reverse plenty of times, but never this. On the face of it, after all, it makes no sense. Shouldn’t my knees be happy to be carrying less weight? Then you look deeper and realize it has a certain logic. My knees and legs were overdeveloped to handle a lot of weight; removing it threw them out of whack. My legs, especially thighs, lost a lot of muscle mass, simply because I wasn’t walking around with an extra 100+ pounds, which meant my knees weren’t as stable. Throw in the fact that I walked and sat differently, crossed my legs sometimes, and used my knees much more by being active, and it starts to all make sense. But I still don’t think a doctor would have told me that up front.

So, then, what about my hormone levels? Would any doctor have actually told me back then that it’s not abnormal for women losing that much weight to get hypothalamic amenorrhea? (I.e, a fancy way of saying they would stop menstruating?) And further, that 20% of such women (a rather high figure) never get back to their normal cycles? It’s one of those things for which there is no known cure. My acupuncturist said she had a lot of success with it, but I saw her for two years with no luck, so I’m not sure what to make of that. Another doctor told me she’d only seen women recover after being pregnant (still possible, but with assistance), as if that reset them somehow.

But maybe a doctor would share that because many women would consider it a plus. No mood swings, no cramps, no mess, no worries about going swimming or hiking or wanting a romantic evening. Sounds perfect, right?

Except, of course, it also means no estrogen in your system. No estrogen means, among other things, loss of bone density. I cannot tell you how horrifying and shocking it was to find out, when I was 30, that I had osteopenia, the stage before osteoporosis. I was 30! But I’d wanted to avoid the pill as a long-term solution because too much estrogen can increase the risk of breast cancer. That’s why I opted for the NuvaRing, which has very low doses of estrogen. Problem is, some studies have shown that if the doses of estrogen are low enough, it can prevent gains in bone density and even cause bone loss. We’re still trying to figure out if that’s what’s going on with me. It’s just frustrating, because as my doctor pointed out, I’m a “unique case”, wanting enough estrogen to protect my bones, but not enough to increase my changes of breast cancer.

Another issue with lack of estrogen is a thinning/drying of reproductive tissue. I actually got an abnormal pap result once not because I had HPV (although that was the initial diagnosis) but because my cells looked like those of a post-menopausal woman, and it threw off the people looking at the cells because I was only 32. Not having a period doesn’t seem quite as exciting when you consider all that.

It’s possible that someone might have told me that keeping a certain amount of fat in my diet is actually important, and that most women need around 20% body fat to maintain a normal cycle. Especially someone like me, who had been used to lots more than that. I don’t know if that would have helped, and I’ll never know now.

Now, I’m not going through all of this to scare women away from losing weight. (Men, I have no idea what you’d go through – sorry.) It’s more that I don’t want people to be blindsided by these things as I was. If you’re comfortable consulting your doctor, I would suggest you do that, and if they’re a good doctor, they might even listen and take you seriously. That way, if you experience any of this, they might be able to help you a little more proactively. But with any luck, you won’t go through this at all, and will just experience the joy of a thinner self.