Are you struggling with hypothalamic amenorrhea and wondering how to recover your period and reclaim your health?
In this episode, Sarah dives deep into your burning questions about HA recovery, covering everything from the causes and symptoms of this condition to the most effective strategies for regaining your menstrual cycle.
Join us as we explore the biochemical reasoning for needing sufficient carbohydrates in your diet, the impact of exercise and stress on HA recovery, and the long-term health implications of leaving this condition untreated.
Whether you’re just starting your recovery journey or looking for additional support and guidance, this episode is packed with insights and tips to help you take the necessary steps towards full recovery.
Now onto today’s podcast which is the most frequently asked questions I get about hypothalamic amenorrhea. These questions range from diagnosis to nutrition and exercise, fertility, health complications and more, so let’s dive in.
The first question I’m going to address might be obvious if you’ve been in the HA recovery world for a little while, but for those of you who are new around here it might be helpful to know the answer to this question, which is: What is hypothalamic amenorrhea, and what causes it?
Hypothalamic Amenorrhea (HA) is a condition where a woman’s menstrual cycle stops due to an imbalance in the hormones that regulate menstruation. Specifically, the hypothalamus, a gland in the brain that controls hormone production, is disrupted, leading to decreased production of gonadotropin-releasing hormone (GnRH). This, in turn, causes a reduction in the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are responsible for stimulating the ovaries to produce estrogen and progesterone, the hormones that regulate menstruation.
There are several known causes of hypothalamic amenorrhea. One of the most common is overexercising and/or undereating, which can cause stress to the body and disrupt hormone production. In fact, many women who struggle with hypothalamic amenorrhea have a history of engaging in excessive exercise or restrictive diets. Other causes may include stress, weight loss, low body fat percentage, thyroid disorders, and certain medications.
It’s important to note that each person’s experience with hypothalamic amenorrhea can be unique. Some women may experience a sudden cessation of their menstrual cycle, while others may experience irregular cycles or lighter periods. For some, the diagnosis may come as a surprise, while for others, it may be a long-awaited explanation for their struggles with fertility or other related health issues.
I personally was always baffled by the fact that I had reached the weight I was told was healthy for my body, yet still didn’t have a period. For many of the women I work with, they’ve often spent years feeling lost and confused by a similar situation. For example, I once had a client who had been a long-distance runner for many years and had always had irregular periods. She had been told by several doctors that it was normal for athletes to have irregular cycles (side note: it’s not normal). It wasn’t until she was ready to try for a baby that she went back to her doctor who said her only option was ovulation induction or IVF. But after doing a bit more research and finding my podcast that she realised she had hypothalamic amenorrhea, and through working together we helped her to regain regular cycles through lifestyle changes and she fell pregnant naturally.
Other clients of mine feel similarly discouraged when they’ve been told by their doctors that their exercise is fine and couldn’t possibly be affecting their cycle, or there’s no way they could have HA because they are at a normal weight. However, these are some of the most misleading reasons as to why women go for YEARS without a cycle when the root cause is hypothalamic amenorrhea.
The second question I want to answer is what are the symptoms of hypothalamic amenorrhea?
HA can show up in a number of ways, but some of the most common symptoms include:
- Absence of periods (amenorrhea): This is often the most noticeable symptom and can be a cause for concern if you are sexually active and trying to conceive.
- Irregular periods: You may experience periods that are less frequent than usual, or ones that come and go seemingly at random.
- Light periods: Your periods may be lighter than usual, or you may only have spotting.
- Difficulty conceiving: HA can make it harder to get pregnant due to the irregular cycles and lack of ovulation.
- Low libido: Hormonal imbalances can affect your sex drive.
- Fatigue: Hormone imbalances and stress can cause you to feel tired all the time.
- Trouble sleeping: Insomnia or difficulty staying asleep can be a symptom of HA.
- Difficulty concentrating: Hormonal imbalances can also affect your ability to focus and concentrate.
- Bone loss: Prolonged amenorrhea can lead to bone loss, which can increase the risk of osteoporosis and fractures.
- Cold intolerance: Hormonal imbalances can affect your body’s ability to regulate temperature, leading to feeling cold all the time.
- Digestive issues: Some women with HA may experience digestive issues like constipation, bloating, or stomach pain.
- Mood changes: Hormonal imbalances can affect your mood, leading to depression, anxiety, irritability, or mood swings.
It’s important to note that these symptoms can also be caused by other conditions, so it’s important to consult a healthcare provider if you’re experiencing any of them.
The next most frequently asked question is: Can hypothalamic amenorrhea be reversed, and if so, how long does it take?
Well the good news is that hypothalamic amenorrhea can be reversed and is completely treatable. The first step in reversing HA is identifying and addressing any underlying causes of the condition. This might include reducing stress levels, addressing disordered eating or exercise patterns, or increasing overall caloric intake to support healthy hormone levels. In some cases, hormonal replacement therapy may be used in conjunction with lifestyle changes for bone protection during recovery.
The length of time it takes to recover from hypothalamic amenorrhea (HA) can vary based on a variety of factors, such as the severity of the condition, the individual’s overall health and how quickly lifestyle modifications are made.
In general, it’s common for women to start seeing improvements in their menstrual cycle within a few months of starting treatment. However, the length of time it takes to fully recover can vary from person to person.
Some women may experience a return to regular menstruation within six months of starting treatment, while others may take up to a year or longer to fully regain regular menstrual cycles. It’s important to keep in mind that the recovery process from HA is a journey, and it may not always be a linear process. That’s why support and getting help to ensure you’re doing all the right things is so important.
For me personally, it took about 6 months for me to regain my period, and even after it initially returned my cycles were somewhat irregular. It’s frustrating that you have to be so patient with yourself and the process, but I’m so glad I did as now my cycles are incredibly regular and my bone mineral density is back to normal now that my hormones are all back to healthy levels.
The next question fits nicely in with the one above as I’ll be answering: How can I tell if I’m making progress in my recovery from hypothalamic amenorrhea? What signs can I look out for before my period returns that let’s me know I’m moving in the right direction?
While getting your period back is obviously the big end goal, there are several things that improve well before you even get your first bleed. Here are a few things to pay attention to:
- Increase in cervical mucus
- More energy
- Stable moods
- Increase in libido
- Less injury and illness as your body is in a more fuelled state
- Improvements in sleep
For a more comprehensive list I’d tune into episode 143 of Holistic Health Radio titled “Signs You’re About to Get Your Period Back in HA Recovery” as that goes through each of these symptoms in much more detail.
Now another common question I get all the time is “how do I know that HA is the cause of my missing or irregular periods?”
This is such a valid question because hypothalamic amenorrhea is only one of MANY causes of a missing or irregular cycle. Getting a formal diagnosis for hypothalamic amenorrhea is actually through a diagnosis of exclusion, where a doctor will rule out all other potential reasons why your period might be MIA before piecing together the puzzle of whether HA looks like the right scenario for you.
And surprise, surprise, I actually have 2 separate podcast episodes that will help answer this particular question in more detail. So if you want to know more about getting a HA diagnosis and if it’s the cause of your missing period I would listen to BOTH episode 101 titled “How do I know if I have hypothalamic amenorrhea? and also episode 65 titled “Is PCOS or Hypothalamic Amenorrhea Causing Your Missing Periods? Here’s How to Tell the Difference”
Now the next few questions relate more directly to the exact changes a person should make during recovery from hypothalamic amenorrhea. The first of which I get day in and day out: How much and what do I need to eat to regain my period?
You’ve probably heard over and over again that you need at least 2500 calories to recover from hypothalamic amenorrhea. While this isn’t a magic number and you may need more, it can be a good place to start
In addition to overall calorie intake, it’s important to focus on consuming a variety of nutrient-dense foods that provide your body with the vitamins, minerals, and macronutrients it needs to function optimally. This includes plenty of whole foods such as fruits, vegetables, whole grains, lean proteins, and healthy fats. At the same time tackling food fears and breaking away from food rules will allow you to eat more freely and include fun foods that nourish your body and soul, which can also help support your recovery and healing your relationship with food.
It’s also important to ensure that you are consuming enough carbohydrates, as these are essential for maintaining healthy hormone levels. The biochemical reasoning for needing sufficient carbohydrates for hypothalamic amenorrhea recovery lies in the role of carbohydrates in the regulation of hormones, specifically insulin and leptin. Insulin is responsible for regulating blood sugar levels, and it also affects the secretion of other hormones, including estrogen and progesterone. Leptin is a hormone that plays a critical role in energy balance and the regulation of the menstrual cycle. Both insulin and leptin can be disrupted in cases of under-eating or low carbohydrate intake, leading to a disruption in the hypothalamic-pituitary-gonadal (HPG) axis and the suppression of reproductive hormones, including estrogen and progesterone.
When the body is in a state of energy deficit, the priority becomes the maintenance of vital bodily functions, such as brain function, rather than reproductive function. By ensuring an adequate intake of carbohydrates, the body can maintain stable blood sugar levels, which in turn helps to regulate insulin and leptin secretion. This can help to restore balance in the HPG axis and support the recovery of reproductive function, including the return of menstrual cycles.
It’s important to note that the amount of carbohydrates needed for hypothalamic amenorrhea recovery may vary from person to person, and it’s important to work with a qualified health professional to determine an appropriate carbohydrate intake based on your own individual needs and health status.
If you want more specific information on what and how to eat for hypothalamic amenorrhea recovery, I’ve also got several previous episodes you should go back and listen to including:
- Episode 149: How Much Do I Need To Eat To Regain My Period?
- Episode 106: Does Meal Timing Matter in Hypothalamic Amenorrhea Recovery?
- Episode 98: How to let go of tracking calories while still eating enough in Hypothalamic Amenorrhea Recovery
Now that we’ve talked about nutrition, you’re probably wondering about exercise changes you need to make too, which is why I’ll be answering another common question of: Can exercise and physical activity impact hypothalamic amenorrhea recovery, and if so, how should I approach exercise during my recovery?
Firstly, the simple answer is YES. Both structured exercise and unstructured physical activity can impact hypothalamic amenorrhea recovery. Excessive or high-intensity exercise can increase stress hormones and suppress reproductive hormones, which can interfere with ovulation and menstruation. Therefore, it is important to approach exercise mindfully and adjust your routine as needed during your recovery.
It is recommended to decrease the intensity and duration of your exercise routine while recovering from hypothalamic amenorrhea. This may involve taking rest days, incorporating more low-impact activities such as walking or yoga, and reducing the overall volume of exercise. It is also important to fuel your body adequately before and after exercise with carbohydrates, protein, and healthy fats.
It’s important to remember that every person’s needs and situations are unique, and what works for one person may not work for another. To learn more about how to approach exercise during recovery I’d check out the following episodes:
- Episode 163 The 7 Fitness Myths You Need to Stop Believing
- Episode 132. Is it unhealthy to stop exercising in HA or ED recovery?
- Episode 118. Best and Worst Workouts for Hypothalamic Amenorrhea Recovery
- Episode 95: How to know if you have an unhealthy relationship with exercise (plus how to fix it)
Next up, let’s talk about stress. I want to do this by answering the question that I often get which is: Can stress management techniques help with hypothalamic amenorrhea recovery?
Again the answer is yes, stress management techniques can help with hypothalamic amenorrhea recovery. Stress can negatively impact the reproductive system by disrupting the hypothalamic-pituitary-ovarian axis, which controls the menstrual cycle. When the body is under stress, it releases cortisol, a hormone that can interfere with the production of reproductive hormones such as estrogen and progesterone.
Incorporating stress management techniques such as mindfulness, deep breathing, yoga, meditation, and adequate sleep can help reduce cortisol levels and improve hormonal balance. Additionally, taking steps to reduce stress in daily life, such as simplifying schedules, setting boundaries, and avoiding overcommitting, can also be helpful.
It’s important to note that stress management alone may not be enough to fully recover from hypothalamic amenorrhea. Other factors such as nutrition, adequate calorie intake, and appropriate exercise also play important roles in recovery. A comprehensive approach that addresses all of these factors is usually most effective in restoring menstrual cycles and overall health. If you want more information on stress and HA I’d check out episode 167 titled The Relationship Between Stress and Hypothalamic Amenorrhea Recovery
The last question that I’m going to be tackling today is: What are the long-term health implications of hypothalamic amenorrhea if left untreated?
If hypothalamic amenorrhea is left untreated, it can lead to several long-term health implications. Since estrogen plays a critical role in maintaining bone density, women with hypothalamic amenorrhea are at an increased risk of osteoporosis and bone fractures.
Hypothalamic amenorrhea can also have implications for cardiovascular health, as low estrogen levels have been linked to increased risk of heart disease.
In addition, hypothalamic amenorrhea can have an impact on fertility. If ovulation is not occurring, pregnancy cannot happen naturally. This can be distressing for women who want to conceive.
It’s also worth noting that hypothalamic amenorrhea can impact mental health. The stress and anxiety associated with infertility and the impact on body image can be challenging for many women. In addition, the lack of estrogen can cause symptoms such as hot flashes, night sweats, and vaginal dryness, which can negatively impact quality of life.
Similar to my other answers today, I go into these impacts in much more detail in episode 81 titled “ The Hidden Health Impacts of Hypothalamic Amenorrhea” so go and check that out if you want more in depth information on the health consequences.
I hope this episode has helped answer some of your burning questions about hypothalamic amenorrhea and empowered you to take the necessary steps towards recovery.
Remember, recovery is not just about getting your period back, it’s about healing your relationship with food, exercise, and your body. It’s a journey that requires patience, perseverance, and self-compassion. You are not alone in this, and there is support available to you. Keep in mind that everyone’s recovery journey is unique, and it’s important to work with a qualified healthcare professional to create an individualised plan that meets your specific needs. Thank you for listening, and I wish you all the best on your road to recovery.
If you’re wanting some extra support in your recovery I encourage you to check out our Healing HA Program below.
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