How to get your period back and recover from hypothalamic amenorrhea
So you’ve lost your period, and you’re struggling to overcome disordered habits and behaviours around food and exercise… Now what? Recovering from hypothalamic amenorrhea (HA) takes work, commitment and time, but it can be done! Here’s how to regain your period and heal HA for good.
What is hypothalamic amenorrhea (HA)?
Hypothalamic amenorrhea is when a female “loses” her period, due to interferences with her hypothalamic-pituitary-ovarian (HPO) axis function. This HPO axis is responsible for regulating reproductive activity and ovarian hormones, so compromising this can have serious consequences, such as an absent menstrual cycle and ovulation. Often, HA is caused by undernutrition (also called low energy availability or energy deficiency), excessive exercise, or overwhelming stress. These factors can “trick” your body into feeling like it’s under threat, and unable to support its regular functions, and as a result it attempts to conserve energy by shutting down some of its functions – with one of the first to go being the menstrual cycle.
How do I know if I have HA?
Sometimes, identifying if you have HA can be challenging – especially if your blood results and body weight aren’t showing physical symptoms of the condition.
HA is the absence of your menstrual cycle, so a missing period is the first warning sign to look out for. If you haven’t had a period in 3 months or longer, this is an indicator that something is not quite right in most cases.
So how do you identify whether you may be experiencing HA? Here are some of the symptoms to keep an eye out for.
- Low levels of hormone production. Especially luteinising hormone (LH) which normally spikes around ovulation and causes the release of an egg, oestrogen which is a female reproductive hormone, and follicle-stimulating hormone (FSH) which supports the maturation of an egg before ovulation. The body essentially presses pause on the production of these reproductive hormones, contributing to the interference with menstruation and ovulation.
- Thin uterine lining or polycystic-appearing ovaries. For example, many smaller follicles may be present on the ovaries.
- Weakened bones. This can present as osteoporosis or osteopenia, low bone density, or more regular stress fractures.
- Feeling constantly cold.
- Having a low libido.
- Feeling excessively tired. This can be due to the low energy availability leaving you feeling exhausted, or by poor sleep – another common symptom of HA. Many people experience waking in the early hours of the morning or during the night feeling really hungry, leading to poor quality sleep. This is the result of both underfuelling your body, but also of increased production of stress hormones, like cortisol and adrenaline, interfering with your sleep quality and duration.
- Brittle hair or hair loss, and weak nails.
- Bowel/digestive issues.
- Low body weight. This is common in sufferers of HA, but it’s absolutely not essential for a diagnosis – HA can occur in women of all body sizes!
- There’s a high incidence of depression and anxiety in people suffering with HA.
- Poor body image, or a hyper-fixation on bodies (your own, and the bodies of others).
- High daily stress levels.
- Having an obsessive fixation on food and your eating behaviours.
- Restrictive eating behaviours (either intentional or unintentional). For example, limiting your portion sizes, avoiding foods or food groups altogether, eating “ultra clean”, avoiding social situations involving food, or feeling extreme guilt after eating.
- Compulsive exercise habits, including taking no/few rest days, feeling guilty if you’re not able to exercise, relying on exercise as your primary stress outlet or coping strategy, using exercise to burn calories or control your weight, only participating in high-intensity or long-duration exercises, and an over reliance on fitness trackers.
These are just some of the warning signs and symptoms indicating you may be suffering from HA. Some people experience few or none of these symptoms, while others will experience almost all of them. If you’re concerned, it’s always a good idea to speak to a health professional to obtain a diagnosis and identify what’s going on for you.
So how can you recover from HA and regain your period?
1. Eat enough.
But what is “enough”? This is the eternal question! The answer isn’t so simple… You need to be eating enough to support your body’s daily activities, including things like breathing, thinking, keeping your heart beating, as well as non-exercise energy expenditure, so things that you do like cooking, cleaning, walking around the house, which are using energy, and additionally any exercise you’re doing in addition to these things.
So this amount will be different for everyone. As a base level, aiming for around 2,500 calories per day, plus refuelling whatever energy output you’re using during exercise activity, is a good place to start. But remember, some will need significantly more than this.
Decreasing your exercise and energy output to ensure your requirements aren’t super high and difficult to achieve can also help you meet this requirement, in addition to increasing your food and energy intake during and beyond recovery.
2. Meal timing matters.
When you eat matters almost as much as how much you eat during recovery.
With HA, your body is already in a state of significant stress, unable to trust that it will be adequately fed and nourished to support its optimal functioning. So if you’re fasting, or going for long periods of time without food, you’re adding to this stress, making your body panic even further, and likely producing more stress hormones like cortisol. This can further interfere with your recovery and menstrual cycle.
It also makes it incredibly difficult to meet your daily energy requirements if you’re not eating often enough during recovery. Even if you’re eating big meals later on in the day, if you’re not eating regularly or adequately in the morning, you’ll enter a “micro deficit” energy balance, causing even more stress to your body. Prioritising adequate energy intake is essential during recovery (and beyond!) so you need to be eating regularly to allow yourself to meet your body’s needs.
As a guideline, you should aim for at least three main meals and three significant snacks (or as we like to call them, “eating occasions”) each day, and you want to make sure you’re eating roughly every three hours. This will not only allow you to get the energy you need throughout the day, but it also prevents digestive distress which can occur if you’re trying to cram your energy intake into a small window of time during the day.
3. What you eat counts.
Want to know what the best diet for recovering from HA is? The short answer: no diet! However, there are several foods and nutrients you need to prioritise during recovery to help regain your period and heal your body.
- Carbohydrates. Carbs are your number one best friend during recovery. They provide the most readily available energy to support your body and its daily activities, and also facilitate the normal production of hormones. Plus, they’re your brain’s main source of energy, so if you’re not getting enough, you’re contributing to your body’s state of stress, telling your body it needs to conserve energy by “pausing” functions like menstruation. Aim to include carbohydrates at every meal and snack, without fail. They’re one of the most crucial nutrients to help you recover from HA!
- Eat your fats. Fats are essential for your body and hormone production, so eating enough fats is super important during recovery. Fats can also be extremely helpful in allowing you to reach your daily energy requirements, and for helping your body feel “safe” enough to resume menstruation and normal function. If you recognise you have a tendency to opt for low-fat or no-fat varieties of food, this is your chance to switch to full-fat varieties to support your reproductive hormones (plus, they’re more delicious too!) and add plenty of fats to your diet each day!
- Calcium is key. As we mentioned earlier, bone density loss and weakened bones is a common side effect or symptom of HA. So, as a result, getting enough calcium from your diet needs to be a priority to support bone health and strength. Add dairy-based foods like yoghurt, cheese and milk to your diet each day if you’re able to, or opt for fortified dairy alternatives where possible.
4. Reconsider your workouts.
As we mentioned, reevaluating your workout routine is essential in recovery. Even if you’re increasing your energy intake, if you’re still exercising excessively and burning loads of energy in the process, you’re unlikely to be able to meet your body’s energy needs. And you’re placing an immense amount of stress on your body.
During recovery you may need to press pause on your workouts altogether, or at least significantly reduce the volume and intensity of exercise you’re doing.
Plus, you need to assess your relationship with exercise, and your motivations for moving your body in the ways that you choose to. Do you exercise in order to prevent your body from changing or gaining weight? Do you focus on burning as many calories as possible during your workouts? Do you workout to burn off or earn your food? Do you always turn to high-intensity or longer-duration movement in order to help you use as much energy as possible?
If the answer is yes to these questions, it’s time to reconsider your relationship with exercise, and take a big step back to allow your body to heal and recover from HA. You want to work towards a place where you move your body for joy and pleasure, and exercise is merely a part of your life, rather than something that dictates your day-to-day schedule and causes immense stress.
5. Evaluate your stress levels.
Stress is an often overlooked cause of HA. If you’re experiencing extreme levels of stress day-to-day, this is likely to again have a detrimental impact on your body and hormone production, and can lead to the shutting down of your menstrual cycle as a result.
While, of course, not all stress can be eliminated from your lifestyle, it’s important to stop and take stock of what areas are causing you the most stress and anxiety day-to-day. Is it your job, your family, your friendships, your fixation on food and body image? Identify the areas that are causing you pain and suffering, and ask yourself: are there ways in which you can mitigate or reduce your stress levels?
For example, if your friendship group is causing you significant stress, maybe it’s time to reevaluate whether you’re spending your time with the best people for you. Friendships should bring you joy and comfort, not overwhelming anxiety! If it’s your job which is stressing you out, can you come up with a plan of how you can hand off some of your more stressful tasks, or even consider looking for a new role elsewhere?
It might take planning and time to reduce significant stressors in your life, but it’s a crucial part of recovery, and of living a life you love and enjoy!
So how long should you expect HA recovery to take?
Again, the answer to this question is highly individual. There are some factors which can delay your recovery, or cause it to take longer, including:
- You’re resisting making the necessary changes to your lifestyle and eating/exercise habits out of fear or discomfort.
- Finding yourself stuck in quasi recovery, or you’re not willing to fully commit and go “all in” to recover from HA.
- Only addressing some of the key pillars in recovery, and neglecting others (for example, working on your eating behaviours but continuing to exercise excessively).
- Denying that you have a problem in the first place. You can’t start to recover until you acknowledge the problem, and seek the support you need!
- You’re unwilling to gain weight or change your body. Body changes are (almost always) a necessary part of recovery. It may be scary and uncomfortable, but it’s also worth it. Your body needs more energy, and if that results in body changes then so be it! It’s the only way forward.
If you can push past the fear and discomfort, you’re well on your way to recovery from HA!
Looking for support, strategies and effective tools to help you recover from HA, restore your period, and regain your health (and life!)? Sign up to our next round of Healing HA for all the resources and support you need to restore your period and achieve full recovery, for good.
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Hi future friends, I’m Sarah King, an Accredited Exercise Physiologist and health coach.
Science, not trends is the foundation of my approach. By nourishing the body and mind with scientific facts we can build foundations for a life of realness, not just wellness.