CW: Infertility, discussion of weight loss and eating disorders
If you’ve been around the fat activist or body positivity communities, you may have heard the axiom “What gets diagnosed in thin people gets prescribed for fat people.” What this means is the medical establishment often encourages fat people to engage in behaviors that would be seen as warning signs in thin people, or overlooks symptoms in fat people that would have them sending thin people to specialists, because ANYTHING is better than being fat, amirite?
For a person born female or assigned female at birth–by this I mean a person in possession of a uterus and ovaries and all those childbearing parts–a BIG warning sign is the cessation of menstrual periods before the age of normal menopause, which, in the United States, is 48-54 years. It often occurs in women with eating disorders, both because of weight loss and the tendency to engage in excessive exercise. Generally speaking, it takes a loss of 10% of body weight to cause amenorrhea.
Let’s look at those numbers. Say a woman who weighs 125 lbs loses 10% of her body weight, or 12.5 lbs. This leaves her weighing 112.5 lbs. If she’s 5’6″, which is an average height in the US, her BMI would be 18. (Personally I despise the BMI as a rating of anything, but it’s what the medical establishment uses, so.) Hey, that’s underweight! Better address that.
Now let’s apply the same reasoning to another 5’6″ tall woman who weighs 200 lbs. She loses 10% of her body weight, or 20 lbs, bringing her weight to 180. Her BMI is now 29. Guess what? She’s still overweight. It doesn’t matter how she lost the weight, or whether she engages in ritualistic eating patterns, or if her periods have stopped. No one will even ask about that. She has to lose over 60 more lbs (achieve a weight of 115 or less) before she hits underweight. I personally know people who started out average, who’ve been hospitalized for an eating disorder at that weight. But if you start out fat, you’ll be congratulated. If you live.
I started menstruating at twelve, and I stopped at fourteen. For five and a half years. My eating disorder hadn’t yet kicked into full force when it happened; I think I’d dropped from 145 lbs to 130. Perfectly within the normal range for a 5’7″ adolescent, despite the way my pediatrician “tsked” over my being “tubby.” No one commented on it. I was just as glad, frankly. Issues of sex and reproduction and sticky fluids disgusted my mother, who left it to the sixth grade film strip to explain matters. When I needed sanitary supplies, I took them from her box of Kotex in the hall closet without mentioning it to anyone. She didn’t hit menopause until after my cycles stopped, so that was convenient. I doubt my dad ever thought about it, despite being the one who did all the shopping for our family. Maybe he believed I got my own supplies somehow. How he thought I achieved this, having no money of my own, I have no idea. My pediatrician complimented me on “slimming down;” later, when I got a bit too thin for his liking, he sent me home with cases of liquid nutritional supplements. They piled up in the pantry, untouched.
Common wisdom is that your cycles are supposed to start again once you gain weight. Mine didn’t. It took a therapist’s intervention and several courses of Provera before that happened.
The reason I rehearse all this old, old information is this: the exact same thing happened the last time I turned my will toward losing a bunch of weight. I was bigger than I’d ever been (though not as big as I am now), and I hated it. More, I hated myself for it. I tried to talk to my then-psychiatrist; I wanted him to understand why it was so difficult and loaded a topic. Despite knowing I’d almost died of anorexia, he just said, “Well, you know how to lose weight. Eat less and be more active. If you really care about your weight, you need to do what’s necessary, not whine about it.”
Deep breath. Can I just take a moment to say how despicable it is for anyone in mental health to use the words “If you really care…?”
Anyway. It took a while, but I decided he probably knew best–he was the doctor, after all. Maybe I was just whining because I was lazy. So, I joined Weight Watchers and boosted my activity. A lot. It worked for a long while. I lost so much weight in the first few weeks that clothes I had just bought fell off of me. And my periods stopped. Again.
That was almost exactly ten years ago; I was forty-four. And while that’s not an unreasonable age to hit menopause, it isn’t quite normal, nor is it normal for women in my genetic line. My mom had cycles well into her fifties, and one of my sisters had her last child at forty-one. I asked my psychiatrist if one of my medications could have caused it; he said no. I asked my primary; she said it was probably perimenopause and my periods would probably be irregular for a number of years, blah, blah, blah, the usual stuff. Which didn’t make any sense to me; they didn’t get irregular, they simply stopped. But no one related it to my weight loss, which, incidentally, they praised. I didn’t bring it up because I was proud of it, and I didn’t want to hear that for some inexplicable reason my body reacts to the slightest weight loss by becoming infertile, which I suspected, and had since I was a teenager. There was still the matter of believing I’d have children some day, despite my age and my mental health issues.
Much later, an acupuncturist told me it probably was the weight loss rather than my age that caused my cycles to stop just then. She may have been saying that to make me feel better, I don’t know. I do know the main reason I stopped “watching my weight” and “let myself” get fat again was that I hoped desperately that, by some magic, it would restore my fertility. It didn’t. The lack of ANY other menopausal symptoms let me hope for a long time, but I’m coming to the place where I think I have to accept that I blew it; I missed my chance for children of my own. It’s hard. I’ve swallowed a lot of bad stuff in my life, but this one…I just can’t seem to get it down. And people suggest adoption (too expensive) or fostering (no space for a person older than three, and I have doubts that we’d pass muster as a foster family), or working with Partners or some other volunteer group, and none of that is what I want. Humility aside, my husband and I are intelligent and educated and self-aware, and I wanted to keep that genetic code in the pool. Too many stupid people breed. I really think that, so sue me.
I can’t forgive my doctors of ten years past for blowing me off. For giving me the easy answers, whether or not they were true (I found out later that Depakote, the mood stabilizer I took at the time and that I’m taking now, has been known to cause PCOS and infertility. I stopped taking it for a long time because of that). For not saying, “Hey, you have a history of anorexia and you’ve lost over 10% of your body weight. Maybe there’s something in that.” I can’t forgive the medical establishment for privileging a specific body size and type over actual health, to the point where the health concerns of those outside that type are routinely ignored. Even at my lowest weight recently, I was still “overweight” by a few points. So obviously there could have been no connection between my early amenorrhea and my weight loss.
But most of all, I can’t forgive myself. As much as I repeat to myself I was in a bad state and in no condition to challenge those with perceived power over me, I can’t forgive myself for not doing it. I can’t forgive myself for not pointing out the correlation between my weight loss and the cessation of my cycles, for not bringing up the similarity to my previous experience. Maybe it wouldn’t have made a difference. At least I would have tried. The thought haunts me, the same way it haunts me how readily I crumpled after two miscarriages when I know women who’ve had three, five, ten, and gone on to have healthy children. Even women in their late forties. As I would have been, had I spoken up.
And sure, there would have been obstacles. Maybe a lot of them. There still would have been my mental health and the financial burden to address, the need to talk my husband around; I might not have been capable of those things. Some people think it’s “selfish” for older parents to have children; there would have been that judgment to face, along with all the judgments parents face. That’s if I even managed to carry a pregnancy to term, no telling what more failures would have done to me. I thought at the time I couldn’t face another miscarriage. Now I see that as cowardice.
Aslan, the godlike Lion in C. S. Lewis’s Narnia books, always tells the human characters, “You can never know what might have been.” My imagination amply provides me with “might have beens” every day, and none of them seem worse than where I am right now. I’d give everything I have for one more chance.
I think this grief and blame and regret will follow me the rest of my days.