“I’m Really Healthy—Except I Don’t Get My Period.”

You’re the picture of health, a dedicated morning runner or an every-day-after-work Cross Fit enthusiast. You follow the vicissitudes of nutritional consensus on gluten the way some people follow basketball or the primaries. You look great in a tank top—healthy, strong, and slender. But there’s one problem, a problem that the friends and colleagues who admire your healthy lifestyle will never notice: your period has gone missing.

If this sounds like you, you may have hypothalamic amenorrhea, a condition where your period stops due to increased stress that usually comes from a combination of over-exercising and under-eating. It’s estimated that 30 percent of women who lose their periods may be suffering from hypothalamic amenorrhea. Many of them don’t realize they have a problem until they decide they want to get pregnant, stop taking birth control pills … and never get their period.

The good news is that in most cases, women with hypothalamic amenorrhea are able to recover and get pregnant naturally. This post answers all your questions about this condition and tells you how to recover.

What are my chances of getting pregnant when I have hypothalamic amenorrhea?

If you have hypothalamic amenorrhea, you won’t be able to get pregnant until you’re recovered. Your doctor may recommend medication to induce ovulation such as Femara or Clomid, but they are more likely to be effective if you’re already actively recovering. If those don’t work, you can go the injectables route, but for healthier pregnancy, breastfeeding, and general wellbeing it’s best to remove the lifestyle factors that caused your amenorrhea in the first place.

What is hypothalamic amenorrhea doing to my health?

Fertility aside, hypothalamic amenorrhea is a serious health issue. It’s associated with bone loss, dry hair and skin, digestive issues, exhaustion, poor sleep, decreased sex drive, and increased risk for heart disease. Luckily, studies show that resuming natural cycles can reverse these changes.

What kinds of women get hypothalamic amenorrhea?

  • Fit, active women: If you exercise a lot and don’t eat enough to fuel your activity, you’re at risk for hypothalamic amenorrhea. There’s no universal body fat percentage or amount of exercise that accurately predicts who will lose her period and who will not—some women may be genetically more susceptible than others. In most cases, it appears that the combination of lots of exercise and low body weight can, at a threshold that varies among individual women, form a potent ovulation-suppressing cocktail.
  • Women with eating disorders: Even in the absence of exercise, extremely restrictive diets can cause hypothalamic amenorrhea.
  • Women of any size who have lost a lot of weight: Not all women with hypothalamic amenorrhea are thin. If you were overweight, then lost weight, you could have hypothalamic amenorrhea, even if you’re at a healthy size.

What’s happening in my body when I don’t get my period?

Your hypothalamus is the part of your brain that regulates sleep, hunger, body temperature, and your menstrual cycle. It releases gonadotropin-releasing hormone (GnRH), which stimulates the release of luteinizing hormone (LH) and follicle-stimulating hormone (FSH)—both hormones essential in the ovulation process. In a woman with hypothalamic amenorrhea, the hypothalamus doesn’t release as much GnRH. As a result, there isn’t enough LH or FSH for ovulation to occur.

How do I recover from hypothalamic amenorrhea?

Your recovery will depend on what lifestyle factors caused you to lose your period in the first place. If you lost a lot of weight, you will need to eat more. If you over-exercised, you may be able to cut back on exercise without changing your diet very much. If you were chronically stressed, you should focus on finding healthy coping techniques like meditation and yoga.
For many women, recovery from hypothalamic amenorrhea requires addressing each of these areas: weight, exercise, and stress. The absence of your period is a sign that your lifestyle is causing your body stress, even if you don’t feel like you’re stressed. Examine your lifestyle, especially the changes you’ve made since losing your period, and think about how to reduce stress.  

How much exercise can I do while I’m trying to get my period back?

As little as you can stand. The fastest way to recover from hypothalamic amenorrhea is to immediately cut out all intense exercise.

Most women who get hypothalamic amenorrhea find it very difficult to cut back their exercise so drastically, and try to increase their calories while keeping their exercise levels the same or only moderately reduced. But exercise itself, regardless of eating habits, has multiple cycle-suppressing effects. Opioids—the mood-boosting chemicals created by exercise—inhibit the secretion of GnRH, an important reproductive hormone. Excessive exercise also suppresses leptin, which stimulates the release of GnRH. Finally, exercise increases cortisol secretion—a sign of physiological stress.

If you’re having trouble reducing your exercise, remember that it’s only temporary. Many women who recover from hypothalamic amenorrhea are able to return to their former exercise routines without losing their cycles again. But it’s very difficult to regain your cycles while exercising intensely.

Even a greatly reduced exercise routine can still be too much for your cycles to return. If you’ve reduced your exercise, increased your calories, and you’re still not getting your period after several months, try limiting yourself to only walking (gentle strolls, not frenzies uphill marches) and yoga (relaxing yoga, not Bikram).  

How much should I eat to regain my cycles?

When you’re recovering from hypothalamic amenorrhea, all food is good food. What your body needs to recover is calories, and it really doesn’t matter much whether those calories come from kale and quinoa or from donuts and chocolate. In fact, you’re probably better off with the donuts than the kale, since eating high fiber, low calorie foods can make you feel full before you’re able to consume enough calories. (Try consuming 500 calories worth of broccoli. It won’t feel—or smell—very good!)

There are a few foods that are helpful to emphasize:

  • Full fat dairy: Recent studies have suggested that women who eat at least once serving of full fat dairy per day are less likely to have ovulatory disorders than those who consume low- or nonfat dairy products. Estrogen dissolves in fat and therefore is present in full fat dairy.
  • Simple carbs: You may be accustomed to avoiding sugar, white bread, and pasta, but these and other high glycemic index foods can be especially helpful in recovering your period. High concentrations of glucose in the body cause your GnRH nerve cells to fire at a faster rate, which leads to an increased production of FSH and LH—and more growing eggs!  

Weight bearing exercise is good for bone mass. Does this offset the bone loss caused by hypothalamic amenorrhea?

Unfortunately, no. The beneficial effects of weight bearing exercise on bone are not sufficient to prevent the adverse effects of estrogen deficiency.

How much weight will I have to gain?

In studies that track women who recovered from hypothalamic amenorrhea, the weight gain tends to bring them to a BMI of 22-23. But everyone is different. How much did you weigh when you first got your period? How much weight did you lose before losing it? 

If you’re an over-exerciser and not really a restrictive eater, you may be able to get your period back simply by cutting back on exercise and not gaining much weight. One study found that injured dancers regained their periods when they couldn’t exercise, even though their body weight did not change.  

Should I go on the pill while I’m recovering from hypothalamic amenorrhea?  

If you’re trying to get pregnant right away, oral contraceptives are obviously not an option.

But for women who aren’t trying to conceive immediately, some doctors prescribe birth control pills. The thinking is that hypothalamic amenorrhea means that you have low levels of the hormones that protect against bone loss, and birth control pills can help offset this. However, the increase in bone mineral density that typically accompanies the return of natural cycles is significantly greater than can be achieved by treatment with birth control pills or other estrogen treatment. In other words, birth control pills won’t help as much as lifestyle changes, and they may mask the underlying problem.  

For the bible on hypothalamic amenorrhea recovery and pregnancy, check out No Period Now What on Amazon.

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