After many years of not having a period and working with hundreds of women, here’s my personal and clinical experience on how to get your period back naturally.
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 three, and then six. 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. The good news is, losing your period often has a clear root cause, and there are things you can do to recover and get your period back naturally.
What is Hypothalamic Amenorrhea?
Hypothalamic amenorrhea is a condition where normal menstrual cycles stop due to eating too few calories, working out too much, or stress (and often due to a combination of all three). Your hypothalamus is an area in your brain that controls reproduction. When your body receives signals that it is under stress, your hypothalamus stops stimulating the release of reproductive hormones that control menstruation.
Aside from not getting your period, hypothalamic amenorrhea is a sign your body doesn’t have all the resources it needs to function properly. With energy in a deficit, your body will shut down what is considers to be unnecessary functions, including your menstrual cycle.
At its root, hypothalamic amenorrhea is a condition of energy imbalance. You’re putting out more than you’re taking in, and your body sees this as a stressor. Research shows stress is a powerful inhibitor of reproductive function. When our body is under chronic stress, it downregulates hormone production, including sex hormone and thyroid hormone production.
While losing your period is often the first sign something is wrong, it can lead to long-term issues down the road.
Causes of Hypothalamic Amenorrhea
Typically, there are a number of different factors that contribute to hypothalamic amenorrhea. Here are some of the causes:
- Emotional or physiological stress
- Long term caloric restriction
- Poor nutrition
- Low body fat (note: this is highly individual)
- Exercising too much
- Having a disordered relationship with food or an eating disorder
Is It Your Weight?
A common myth about hypothalamic amenorrhea is it only happens to college athletes or those who are suffering with eating disorders who are very lean or 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 will make you lose your period. It is completely individual to you and your body.
While having a lower body fat percentage can play a part, you don’t have to be underweight according to the BMI chart to lose your period, you just need to be under the weight that is right for you. This means even a “healthy” weight can trigger hypothalamic amenorrhea if it is too low for your body.
In fact, the majority of women I meet who lose their period 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 an important indicator of your health. In fact, according to some experts, your menstrual cycle is your 6th vital sign.
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.
Even if you don’t want to have kids now or ever, your body needs a menstrual cycle for healthy hormone production. 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.
Hypothalamic Amenorrhea Diagnosis
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 if you have it. Instead, it is diagnosed through exclusion. To determine if you have it, 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 to start making shifts that will allow you to get your period back naturally.
What About Birth Control?
After you’ve been diagnosed with hypothalamic amenorrhea, your doctor might suggest starting hormonal birth control pills. Unfortunately, this does nothing to solve the root issue.
I’m just going to be honest: this makes absolutely no sense.
The hormonal birth control pill works by stopping ovulation, but if you have hypothalamic amenorrhea, 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 it’s resolved. Remember, hypothalamic amenorrhea is caused by an energy imbalance. Taking hormonal birth control does nothing to fix the root cause, it simply gives your body synthetic hormones to create a bleed.
If you’re struggling to get your period back after the pill, check out How to Stop Taking Birth Control (Without Side Effects).
How to Get Your Period Back Naturally
If I had to sum up how you can heal hypothalamic amenorrhea in one sentence it would be: eat more, exercise less.
Because it is caused by an energy imbalance, the only way to get your period back naturally is to correct that imbalance. The energy imbalance is a major source of stress, which is shutting down hormone production. Stress has a profound impact on your endocrine system, and unless you deal with the root cause of the stress and the imbalance, you won’t be able to reverse hypothalamic amenhorrea.
It’s also important to remember that eating too little puts your body in a state of nutrient deficiency. So, if you’ve been chronically cutting calories and working out a ton, your body isn’t going to have the raw materials needed to create and secrete hormones. There are other functions that take priority, like the stress response, which is why your body shuts down your menstrual cycle.
The fastest way to recover from hypothalamic amenorrhea is to stop intense exercise and eat above your calories needs.
Think of the energy imbalance like a big, deep hole. Not only do you need to stop digging it deeper, 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.
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 hypothalamic amenorrhea 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.
There’s no set number or body fat percentage to strive for, but you’ll know you’ve gained enough weight when you get your period back. Essentially, you are trying to get to a place where your body knows there is enough energy available, hormones have the nutrients they need, and cortisol is within normal ranges.
What to Eat
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. Supplying your body with quality nutrients is the entire basis of my book, Coconut and Kettlebells. If you lost your period, 2,300 – 2,500 calories per day is a good place to start.
You don’t have to track calories, and you should never stop eating if you’re still hungry. 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 hypothalamic amenorrhea are carbohydrates. In fact, according to Dr. Lara Briden, even if you’re getting adequate calories, undereating carbohydrates can trigger it 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. Here are some of my favorite nutrient-dense carbohydrate sources:
- Sweet potatoes
- Jasmine or short grain brown rice
- Oats! Try oatmeal, oat flour pancakes or waffles, coconut milk overnight oats, etc.
- Fruits, including bananas, berries, apples, and more!
- Sprouted or sourdough bread
Yes, food quality matters. But, you might benefit from adding more calorie-dense (and dare I say refined) foods into your diet.
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.
The amount of exercise that can trigger hypothalamic amenorrhea 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 hypothalamic amenorrhea, but any intense exercise or cardio will add stress. While workouts are stress relieving, intense exercise literally breaks down muscle tissue requires energy.
The best exercise you can do while trying to get your period back naturally 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.
To heal hypothalamic amenorrhea, you have to be willing to change what you think of as healthy and start taking action to encourage a healthy body image. 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 it.
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?
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). But, in most cases, it can take anywhere from 3 to 6 months. If your period has been MIA for years, it probably is going to be on the longer end of that.
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.
What to Do When You Get Your Period Back
It finally happened: you got your period back!
It’s incredibly gratifying to recover, but as soon as you get it back, 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. When you reach this state, it’s important to continue to balance hormones naturally long-term. Always be aware of how stress can impact your period and your hormones.
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 the following podcast episodes: