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It starts like this: one month, you don’t get your period.
You know you aren’t pregnant, so your missing period doesn’t seem like a big deal. Truth be told, it’s kind of convenient.
But then one month turns into 3… Then 6… Suddenly you can’t remember when your last period was. Is this really ok?
For thousands of women, this is how hypothalamic amenorrhea (HA) begins. And while it happens to many, it’s not normal and can turn into a serious issue. The good news is, HA is a condition that often has a clear root cause, and there are things you can do to recover and get your period back.
What is Hypothalamic Amenorrhea?
Hypothalamic amenorrhea is a condition where normal menstrual cycles stop due to undereating, over-exercise, or stress (and often due to a combination of all 3).
Aside from a lack of period, HA is a sure sign your body doesn’t have all the resources it needs to function properly. With energy in a deficit, your body will shut down “unnecessary” functions, including your menstrual cycle.
At its root, HA is a condition of energy imbalance. You’re putting out more than you’re taking in.
A major myth about HA is it only happens to college athletes who exercise hours a day, or those suffering with eating disorders who are dangerously underweight. But the truth is it can happen to anyone who winds up in an energy imbalance.
There’s no “magic number”—be it hours of exercise per week, body fat percentage, or weight—that is known to cause HA. It is completely individual to you and your body.
You don’t have to be underweight according to the BMI chart to develop HA, you just need to be under the weight that is right for you. This means even a “healthy” weight can trigger HA if it is too low for your body.
In fact, the majority of women I meet who develop HA are very surprised when their period goes missing. They think they’re just “being healthy.” If this is what happened to you, remember: it’s never healthy to lose your period. When your period is missing, it’s a sign that there is some imbalance in your body.
Why Losing Your Period Matters
When you’re of childbearing age, a regular menstrual cycle is one of the most important indicators of your health.
Losing your period is like a big, blaring siren warning you that your body is experiencing an imbalance. Even if right now, the only “symptom” is your period missing, hypothalamic amenorrhea is a sign that there is a bigger issue going on.
Hormone imbalances, acne, thyroid and adrenal dysfunction, fatigue, and mood disorders can all come alongside HA.
Even if you don’t want to have kids now or ever, your body needs a menstrual cycle to stay healthy. Ovulation is necessary for the production of estrogen. If you’re not ovulating, estrogen levels will drop and your risk of osteoporosis and stress fractures increases.
The bottom line is that women of childbearing age need to be ovulating regularly to stay healthy. When your period has gone missing, there is a root cause, and that root cause is likely creating other dysfunction in the body.
How Do I Know If I Have Hypothalamic Amenorrhea?
If your period unexpectedly disappears, you should always talk with your doctor. Don’t just assume it’s hypothalamic amenorrhea (or anything else).
There’s no blood test or scan that can tell you for certain if you have HA. Instead, it is diagnosed through exclusion. To determine if you have HA, your doctor will first need to rule out other causes of missed periods:
- Are you pregnant? This one is pretty self-explanatory, but it should always be ruled out first.
- Do you have PCOS? Polycystic Ovarian Syndrome is another major cause of missing periods and irregular ovulation, but it’s not the same as HA (and they don’t usually occur at the same time). PCOS is a disorder caused by excess androgens, where HA is caused by energy imbalance.
- Are you using hormonal birth control? Some hormonal birth control methods (like the Pill, ring, shot, and hormonal IUD) can cause you to stop bleeding entirely, even during the “placebo week.” But the absence of bleeding you might have on the Pill isn’t the same as HA, as HA is about the absence of ovulation, not just the absence of blood.
If you and your doctor conclude you do have hypothalamic amenorrhea, the next step is deciding how to treat it.
If You Have Hypothalamic Amenorrhea, Don’t Do This
If you’ve been diagnosed with hypothalamic amenorrhea, your doctor might suggest starting hormonal birth control pills.
I’m just going to be honest: this makes absolutely no sense.
First of all, the hormonal birth control works by stopping ovulation, but if you have HA, you’re already not ovulating.
All the Pill might be able to do is give you a monthly “pill bleed,” which is not the same as a true period caused by ovulation, and doesn’t have the same health benefits.
And even if you do get a “pill beed,” it doesn’t mean your HA is resolved. Remember, HA is caused by an energy imbalance. Taking hormonal birth control does nothing to fix the root cause of HA: the energy imbalance.
How To Heal Hypothalamic Amenorrhea
If I had to sum up how you can heal hypothalamic amenorrhea in one sentence it would be: eat more, exercise less.
Because HA is caused by an energy imbalance, the only way to truly heal it is to correct that imbalance.
The fastest way to recover from HA is to stop all exercise (except normal daily movement) and eat above your calories needs (aka in a calorie surplus). If you listen to my podcast, you’ve heard Stef and I call this “Eating All The Things.”
Think of the energy imbalance caused by HA like a big, deep hole. Not only do you need to stop digging it deeper (with exercise and restricting your food), but you also have to fill it back in. That’s why eating not just enough calories for your daily needs—but a surplus of calories—is so important.
You can take a more moderate approach, too by reducing exercise and slowly increasing your calories, but it will definitely take longer to recover this way (and you might ultimately have to go “all-in” to recover).
Real Talk: Yes, Your Body Might Need to Gain Weight
No matter which option you choose, you will most likely need to gain weight in order to heal your hypothalamic amenorrhea.
Gaining weight is completely OK. Doing so doesn’t mean you’ll be less healthy (in fact, it means exactly the opposite), less worthy of a person, or that you’ll be less happy.
If your period went missing while you were pursing a certain weight you thought you should be, it’s important to recognize that your health and happiness is not a destination. Weight loss doesn’t equate to improved health, and there isn’t a linear relationship between leanness and happiness.
Very few women can reverse HA without gaining some body fat. Yes, even women who are at what most people would consider a “healthy weight” may have to gain weight to get their period back.
For most women, you’ll need to get back to the weight you were at the last time you had a period, and you may have to even go above that to get your period back. There’s no set number to strive for, but you’ll know you’ve gained enough weight when you get your period back.
Eating All The Things
When it comes to healing hypothalamic amenorrhea, food quantity is more important than anything else. You’ve got to have enough food to fill that hole back in.
I recommend 2,000 calories a day as a minimum for women who are already healthy. If you have HA, 2,300 – 2,500 calories per day is a good place to start, but know that you might need to go higher (especially if you’re more active).
You don’t have to track calories, and you should never stop eating if you’re still hungry but have met your “goal” for the day. That being said, if you’ve been undereating for a long time, you might need to count calories temporarily just to be certain you’re eating enough.
After food quantity, the most important food for healing HA are carbohydrates. In fact, according to Dr. Lara Briden, even if you’re getting adequate calories, undereating carbohydrates can trigger HA for some women.
Yes, some women can eat a low-carb diet without losing their period. But just because it works for them, doesn’t mean it works for you. If you have HA, you must eat carbohydrates to recover.
(And if you’ve gone low carb for your “health” but it’s led to developing HA? That means low-carb eating isn’t healthy for you in this stage of life.)
What about food quality? Yes, it still matters, and you don’t necessarily want to go headfirst into a box of Lucky Charms. But you might benefit from adding more calorie-dense (and dare I say refined) foods into your diet. Think foods like oatmeal, rice, and quinoa.
Taking the stress out of eating and exercise is what this is really all about. You shouldn’t be stressing about making the “right” food choice all the time. Try and listen to your body, eat what you’re craving when you’re hungry, and stop when you’re full. Sometimes you might eat too much or too little, but that’s all part of the journey.
Can I Exercise If I Have Hypothalamic Amenorrhea?
The amount of exercise that can trigger hypothalamic amenorrhea (and the amount that’s safe for women who are trying to recover) is all relative. What’s too much for another person might be OK for you, and vice versa.
In general, if you’re wondering if what you’re doing is “too much,” it probably is. When in doubt, do less. (This is especially true for longer-duration cardio, like running).
There will be time for more exercise when you’ve recovered from HA, but right now any exercise you’re doing is only further stressing your body out. That means you’re not reaping the benefits of this exercise, it is actually making you more unhealthy.
The best exercise you can do while healing HA is the simple, gentle, and joyful stuff: walking outside, yoga, swimming, and hiking are all good options.
The only rule is it has to be fun and feel good. If you’re exhausted after a long day, and your body is begging you to lay down for a few minutes, that outside walk is going to do more harm than good.
Cutting out all exercise and focusing on just your normal daily movement might be what is best for your body right now. (And I promise, you won’t become “lazy” or unhealthy by doing so.)
The Mental Journey
To heal hypothalamic amenorrhea, you have to be willing to change what you think of as healthy. That can be scary, especially if you’re a type-A kind of person who thrives on order and control. In fact, type-A personalities are the ones who are prone to experience HA.
It can feel like throwing caution to the wind. When else has anyone ever said you should eat MORE and exercise LESS to become more healthy?
The truth is, a lot of what our culture calls “healthy” is really based on appearance. True health has nothing to do with what your body looks like, how many hours you exercise per week, or what you body fat percentage is.
How do so many of us end up spending weeks, months, and years chasing after a specific weight or size? The diet and fitness industry thrives on making you feel shame for how you look. In order for you to buy into the next diet, program, or product line, you must believe you need to be something else in order to be happy.
And so, the majority of the marketing you’ll see from diet and fitness brands is laced with shame. It’s designed to make you believe there is something wrong with you, and that it needs to be fixed (with their special product, of course).
Consider this: there isn’t actually anything wrong with your weight if you’re happy and healthy and can do the things you want to do. You don’t actually need to “get rid of” your cellulite. And having a “flat belly” doesn’t make you more worthy of a person.
How Long Does It Take To Heal Hypothalamic Amenorrhea?
The more “hardcore” you go in exercising less and eating more, the faster you can expect to get your period back.
In general, the amount of time it takes to heal hypothalamic amenorrhea usually correlates with how long your period has been missing (and how long you were undereating and over-exercising before that). If your period has been MIA for years, it probably isn’t going to come back from just one month of eating more.
If you’ve been eating more and exercising less for more than 6 months and your period still hasn’t come back, the first thing to do is get real with yourself.
- Are you really eating enough, consistently?
- Have you cut back on exercise enough?
- What else in your life could be creating excess stress for your body?
You should also check in with your practitioner again. It may just take longer for you to recover your period. I have heard from women who have required 2+ years of consistently working toward recovery to regain their period—often by finally doing things they thought they’d never do.
Keeping Hypothalamic Amenorrhea Away
It finally happened: you got your period back!
It’s incredibly gratifying to recover from HA, but as soon as you have healed, you’re going to be thinking about something else: what do I need to do to keep this from happening again?
If you immediately go back to your former exercise routine and restrict your caloric intake, you will lose your period again. This is because your body responds to stress in a very specific way—by stopping mensuration—and that response will not change.
Once your period returns, I recommend slowly increasing your exercise over time while maintaining your caloric intake. Just keep in mind, your old habits weren’t healthy and you don’t want to return to them. If anything happens to your cycle during this time—it becomes lighter, longer, or disappears again—reduce the intensity of your training and ramp it down until your period normalizes again.
Eventually, you should find a “sweet spot” where your body can exist and be in balance.
Hypothalamic Amenorrhea Forces Us To Rethink “Health”
Treating hypothalamic amenorrhea requires you to completely reevaluate everything you’ve been taught about health.
I know how scary and uncomfortable it is to have long-held beliefs questioned. But know this: when you heal your HA, you will develop a much more powerful, true knowledge of what health is for you.
It’s not easy, but it’s so worth it.
Want more resources and insight regarding recovering from hypothalamic amenorrhea? Check out these podcast episodes.