Hypothalamic Amenorrhea – How to get your period back
What is hypothalamic amenorrhea?
The Cleveland Clinic gives a great definition of this. So as not to recreate the wheel, here it is: Hypothalamic amenorrhea (functional hypothalamic amenorrhea or FHA) is a condition where you don’t get your period (menstruate) because of a problem involving your hypothalamus. Your hypothalamus is the control center of your brain — it regulates many bodily responses such as your temperature, hunger and certain aspects of reproduction. Specifically, it releases gonadotropin-releasing hormone (GnRH), a hormone that works with follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estrogen to control menstruation.
Your hormones become unbalanced when your hypothalamus stops producing GnRH. This leads to irregular or absent periods.
Your hypothalamus is the command center for several bodily processes. It sends and receives messages, and signals other hormones to release chemicals into your bloodstream. When your hypothalamus gets a message that something is stressing your body, it can decide to go on strike (or stop working). That means it stops secreting GnRH, which is an important hormone for menstruation.
Reasons your hypothalamus may stop secreting hormones include:
Not eating enough food or restricting food.
Poor nutrition.
Excessive exercise.
Emotional or psychological stress.
Low body fat.
Having an eating disorder such as anorexia nervosa.
Often, it’s a combination of all of these factors that lead to FHA (like exercising too much and not eating enough calories). This puts your hypothalamus in survival mode, putting certain bodily processes and functions on hold so it can focus on the most important ones (like breathing).
My experience with hypothalamic amenorrhea – how I lost my period and how I got it back
I personally went through hypothalamic amenorrhea when I was in my 20s. You can read more about my story HERE and listen to my podcast about it here. I first started dieting when I was 16. At 5’2” and 120lbs, I decided I needed to lose weight. It was a ridiculous thought since I am now very happy at a weight of 120lbs, but teenagers often have warped sense of what their own bodies look like. So I started running and watching my calories. There were no smartphones then so I did it the old fashioned way...by counting calories in my head. Getting most of my nutrition education at that time from teen magazines, I decided I should eat 1500 calories per day to lose weight. And I did...very quickly and easily. At first, it was great. I was skinny and felt completely in control of my body. And for a Type A/control freak like myself, this was a great feeling. However, after about a year or so, I stopped having regular periods (I hadn’t quite gotten to the point having them every month as I just started my period at age 15, but they basically stopped after many months of dieting). Also, despite keeping my calories right around 1500, I very slowly started to gain back some of the weight I had lost.
Left: during my time of hypothalamic amenorrhea, Right: After reverse dieting and getting my cycle back
Fast forward 5 years and I was back to a weight ABOVE 120, but still running regularly and only eating about 1600 calories per day. I also was not getting a period at all (unless on birth control, which is definitely a “fake” period and not a sign that my body was working properly). It wasn’t until I was about 25 years old and wanted to start trying to get pregnant that I realized I had really done a number on my body. Settings the negative physique side effects aside for now (which were just as difficult on me mentally), I realized that I had gotten myself into quite a mess. And sadly, it was not one that any doctor was able to help me with. I was told by my gynecologist I wasn’t lean enough to lose my period so that couldn’t be the issue. I was simply told to use birth control. I was eventually put on clomid by a reproductive endocrinologist, which, didn’t work either since I wasn’t ovulating. I eventually figured out all on my own that I had hypothalamic amenorrhea and knew I needed to get my calories up and cut back on cardio to fix it. All of this knowledge I gained came from reading forums of other women who were diagnosing themselves with hypothalamic amenorrhea and doing the work themselves to get their cycles back. Not a single doctor was helpful during his time.
While I ended up getting pregnant with the help of injections, once I had my first baby, I told myself I would NEVER let myself get back to that spot. I still remember getting my first natural period about 9 moths after having my first baby. It was my first natural period in probably 7 or 8 years and it was an amazing feeling. Since then, I have kept myself cycling regularly through proper nourishment, dieting as infrequently as possible, not overdoing cardio, and being aware of the effects that being in a caloric deficit can have.
Will dieting cause you to lose your period?
As noted above, dieting on too few calories for too long can definitely impact your body’s ability to ovulate and have a natural cycle. It is fairly common for women who are restricting calories (especially for more than just a few months) to lose their period. The threshold seems to vary by person. Some women can get very lean with no negative hormonal effects, but others can barely go below 20% bodyfat before they start to see issues. It appears to be more of an energy balance issue than simply the fact that one has hit a certain bodyfat threshold. I personally wasn’t even very lean any more when I lost my period, but my body was not getting the fuel it needed to tell my body that it was okay to ovulate.
Will running or working out cause you to lose your period?
Just like with dieting, if you are creating a caloric deficit through excessive exercise, you can lose your period. Again, some people can handle a lot more exercise than others, but if you take this caloric deficit too far for too long, it can cause hypothalamic amenorrhea. This deficit can be created by diet, exercise, or a combination of both. Cardio, especially very long or very intense cardio, are much more likely to cause than than something like walking or weight lifting.
Can you have hypothalamic amenorrhea even if you aren’t underweight?
YES! I say this from personal experience but also from working with many women who have lost their periods from under-eating and/or over-training. Many of them (including myself) were not underweight at all. In fact, while we may have caused the issue from initially losing a lot of weight, many of us eventually rebounded and got to a place where we were still restricting calories but our bodies were fighting us and having a really hard time losing weight.
How to get your period back?
If you have lost your period due to an energy balance issue (and no other medical reasons), you simply need to give your body the signals it needs to know that it’s going to be properly fueled and that it’s okay to ovulate and, potentially, carry a baby. We have worked with several women who have come to us because they are in this situation and helping them get their cycle back is one of the most gratifying results I have ever achieved as a coach. Because of my personal experience, I know just how hard it can be to want to get pregnant but to also know your body is not functioning properly.
The first thing I do when trying to help women in this situation is to assess their current calorie intake and workout program. Although everyone’s calorie needs are different, most women need to be at least consuming their ideal bodyweight (not their actual bodyweight if overweight) x 14-16 in order to not experience negative hormonal effects. If they are lower than this, the first step would be to walk their calories up while also cutting back on cardio, especially HIIT cardio. This can be a scary journey for anyone who has been restricting their food in order to control how their body looks. However, it is a necessary one to get your fertility back. Further, this long-term restriction can also impact your metabolism in a negative way. It is very possible to get to a point where even eating low calories, you are no longer able to lose weight.
Most women have been able to get their cycle back simply from getting out of that deficit and properly fueling their bodies again. I remember from my time obsessively reading/participating in the hypothalamic amenorrhea forum that almost every single woman on there who truly put in the work and got their calories back up was able to eventually ovulate again. It took some more time than others, but most everyone was able to fix the issue eventually. Sadly, it was always something they were doing on their own with no help or even understanding from a doctor.
If you are in this situation and would like some guidance getting out of it in a safe and healthy way, definitely reach out to us! We have helped several women get their cycles back naturally using the methods described above.
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