Are you someone who has recovered from hypothalamic amenorrhea and wondering if you can train hard again? The short answer is yes, but the long answer is maybe. In this episode of Holistic Health Radio, I, Sarah Liz King, an exercise physiologist and health coach, discuss the conditions that need to be met before increasing exercise and emphasise the importance of taking a slow and sustainable approach to avoid the risk of losing one’s period again.
I explain that finding the right balance for you when it comes to exercise is key. This means focusing on well-structured training sessions with plenty of rest in between, rather than pushing oneself to do more and risking overtraining, and losing your period again. Adequate fuelling and prioritising rest and recovery are also essential. I recommend working with a sports dietitian or nutritionist to ensure adequate fuelling and protein intake without the need for calorie counting or weighing food.
In this episode, I also provide more specific nutrition tips, such as the importance of consuming enough carbohydrates to fuel workouts and replenish glycogen stores, as well as the role of healthy fats in hormone production. I also discuss the potential benefits of incorporating strength training into one’s exercise routine to support bone health and overall well-being.
The most valuable lesson from this podcast is that prioritising one’s health and well-being when it comes to exercise is crucial. By taking a slow and sustainable approach and seeking professional guidance, it is possible to train hard and enjoy all types of exercise while maintaining a healthy menstrual cycle. So, if you’re someone who has recovered from hypothalamic amenorrhea and looking to increase your exercise, make sure to listen to this episode.
Sarah Liz King (00:00:02) – Hi everyone, and welcome back to Holistic Health Radio. I’m your host, Sarah Louise King. I’m an exercise physiologist and health coach, empowering you to find your healthy balance with food, fitness and your body Through my 1 to 1 and group coaching programs, both myself and my team help women regain their periods, find food freedom, and have a healthy relationship with exercise, all while gaining body confidence. As you would have gathered by the title of today’s episode, we are going to be answering the question. Will I ever be able to train hard again if I have had hypothalamic amenorrhea in the past? Now, there’s obviously a short answer to this and a much longer answer to this. And obviously I’m going to go into a little bit more detail around the longer side of the answer and also address the question, will I ever be able to safely lose weight or change my body composition if I’ve had hypothalamic amenorrhea in the past? Will I ever be able to resume like endurance, exercise or long distance running again if I’ve had in the past? Or how will I know if I’m pushing too hard exercise wise, or putting myself at risk of losing my period again once I start increasing my exercise after recovery? So let’s start with the answer to the first question Can I ever train hard again? If I’ve had a history of hypothalamic amenorrhea, but I have now recovered.
Sarah Liz King (00:01:35) – Now the short answer is yes. The long answer is maybe so long as you kind of meet a few different conditions. Now. The first thing to keep in mind is do you have sufficient estrogen levels? Because obviously exercise is a form of stress, right? It is a form of energy expenditure. And also independently of that, it increases our cortisol levels. And if you’ve been following me for a while, you would know that increased cortisol is not good for our reproductive hormones because it fights for a competition. So either our body and our brain produces cortisol or it prioritizes producing sex hormones like good night and releasing hormone FSH. LH Estrogen, all of those, right? So considering you’ve recovered from hypothalamic amenorrhea, which means at least three consecutive recovery periods before you change any exercise, and that those three recovery periods actually show us that you are in a good place physiologically with your hormones. So what does that mean? How do you actually know that you have sufficient estrogen levels? Well, there’s a few things that you can pay attention to, and this is what I would be doing before you change any of your exercise again.
Sarah Liz King (00:03:01) – Right. So what is the regularity of your cycle like? Right? So obviously, when people’s periods first return, sometimes they like go back into a rhythm straight away, sometimes they take a lot longer to kind of get back into that rhythm because your brain and your body are kind of figuring out how to do all of this again. But ideally, in a perfect world, we want your cycles to be roughly 28 to 35 days spaced apart. Day one is the first day of your periods. The first day you start bleeding. So day one to day one, the number of days in between, that’s how many days apart your cycle is. And we also want to be making sure that your period is actually sufficient in terms of flow. So spotting doesn’t count. So if you’re only having like really light spotting and you’re not really having to change whatever period kind of products you’re using during that time where you think you’re having your period, it’s actually probably more of a just kind of your body trying to get to a menstrual cycle but not actually doing it.
Sarah Liz King (00:04:03) – So that doesn’t count. Your periods should last anywhere between. Two and up to seven days, and you should be having to change the period products that you’re using a couple of times throughout the day. We know obviously, as you get towards the tail end of your period, it gets a little bit lighter, but you want kind of a strong, strong ish, heavy normal flow for at least a few of those days. And that’s how you know that your body has produced enough estrogen to obviously ovulate, build up the lining of your uterus. If pregnancy doesn’t happen, then obviously you’re going to shed the lining of that uterus and have a nice, healthy menstrual cycle flow. So that’s one way of showing or telling that you have sufficient estrogen levels. The second way is with a blood test. Now, I will make a caveat. A lot of people try and do these like. Dutch test, which is a urine test. That’s not an accurate way of testing your hormones because it is the breakdown and the byproducts of breaking down estrogen.
Sarah Liz King (00:05:03) – It’s not a gold standard for testing your hormone levels. It’s not what I would recommend if it were. That is what fertility specialist would be using. And they are not. They are using blood tests. Now, obviously, blood test is a snapshot in time. It’s more helpful to know where you might be at in your circle because obviously the reference ranges do change depending on where you’re at over that kind of 28 to 35 day cycle. So we need to kind of know where you think you are in your cycle and compare where your estrogen levels are and also your FSH and your LH to make sure that they are at the right kind of levels for where you should be. Right. And then if you’re if your estrogen levels are in that healthy, normal range, you should be getting regular cycles anyway. But if your estrogen is really, really low or undetectable, we know you’re probably still struggling with either an artery cycles or a little bit of low energy availability. And so in that case, I wouldn’t be increasing your exercise yet.
Sarah Liz King (00:06:01) – And then also signs and symptoms. So if you have low estrogen, you can kind of think of this as the same signs and symptoms you would be getting in or even kind of like menopause. So hot flashes, vaginal dryness, vaginal dryness, low libido, mood swings, fatigue. If you’re noticing any of those things happening, it could be that low, low hormones are at play. And I would be taking a very cautious approach to your exercise instead of throwing yourself into a high intensity form of exercise. Now, if you’re like, my estrogen is great, I’ve checked it on a blood test. I know that from tracking my periods are really regular. They’re a good length, good flow. I can consistently kind of. Another one is that consistently being able to confirm when you ovulate. That could be through tracking your basal body temperature. So taking your temperature at the same time every day, first thing upon rising upon waking up. Or it could be through things like tracking your cervical mucus. So looking for things like your egg white cervical mucus and seeing it consistently on a similar time of every month.
Sarah Liz King (00:07:11) – So before re-engaging in any exercise or changing your exercise routine, it’s crucial to ensure that your estrogen levels have stabilized and they are within a healthy range. This is important because low estrogen levels can put you at risk of various different health conditions. Obviously, if you have low bone mineral density, it can make that worse. It can put you at risk of cardiovascular disease, all kinds of different things. So very, very important that you don’t just see your period and go like, oh, I’m fine, but actually make sure that your estrogen levels are sufficient and you’re having at least those three regularly spaced cycles before you start. So it might take you six months to get those 328 to 35 consecutive cycles before you start changing up your exercise routine. So that’s the first thing that you need to consider before you’re like, Can I train hard again? Is training Hard is a privilege of kind of meeting all of these conditions. The second thing is gradually increasing your exercise. If you’re doing like absolutely nothing or like slow, gentle walks and then you’re like, I’m going to go to the gym and like, hit the weights hard four times a week, you are going to put yourself at risk of redeveloping hypothalamic amenorrhea.
Sarah Liz King (00:08:22) – You have to take this slow, like really, really, really slow. And that might be a little bit painful for you because you’ve probably been itching to get back to doing the kinds of training that you really, really love. But try and zoom out a little bit and see it as a long term reintegration of doing the things that you love. Because if you do it and you take a slow and sustainable approach, your risk of. Losing your period again is significantly reduced compared to if you were to just throw yourself in the deep end and go like, Oh, I’m just going to like get back into running long distance or I’m just going to like hit the gym hard. I know it might feel good, especially in the short term, but your body is also sensing those stress levels as well. And like I said, I have said previously in different podcasts like your body is really sensitive in those first 12 months. We need to give it the best possible chance to make sure that your cycle stays while you re-engage and doing all the things that you like, particularly exercise wise.
Sarah Liz King (00:09:25) – So if you are increasing your exercise, my suggestion. Is to only change one variable a month. Again, I know it seems slow, but it’s better to be safe than to be sorry. So this means the one variable can either be intensity or volume. So how hard you’re pushing or how much you’re doing. Not both. Just one. Right. And you’re going to decide what that change is. And you want to make it a change of about 10%, right? Not huge either. An increase in volume or an increase in intensity. And then you hold yourself. There you go. I’m going to see how my body responds to this change. If everything goes well, your cycle remains. Then you know that next month you can change one more variable. But if you decide to change so many variables like the type of exercise that you’re doing, the amount of exercise you’re doing and the intensity, it’s going to be really hard to define and pinpoint which one of those changes actually led to. Maybe your cycles getting longer again or you losing your cycle.
Sarah Liz King (00:10:34) – So take it slow and gradually increase. It might take you longer to get back to the amount and the intensity that you want to be doing, but also the benefit is. You’re not losing your period again. So try and like I said, zoom out and see the bigger picture. Now, the third thing that you must be doing if you want to re-engage in higher intensity training, is fueling adequately around your workouts and also in between your workouts. If you think you can just like casually increase how much exercise you’re doing and pay zero attention to your nutrition, you have another thing coming. That’s not how this works. As a person that has had hypothalamic amenorrhea in the past, we know that your body is sensitive to changes in energy. That means if you are spending more energy through movement, whether that be through more incidental exercise, like maybe you just want to go for more walks or more structured exercise like workouts, taking up, you know, running gym, all of that stuff. Again, you have to eat more to fuel that.
Sarah Liz King (00:11:42) – So there’s two important things to keep in mind when it comes to fueling around your workouts and also in between the first one, energy availability in general, you need to be making sure that you are covering off the cost of activities, of daily living, getting up, doing your job, all of the things that you are required to just do in a day and also whatever kind of movement, exercise, incidental activity you’re doing. Your body needs enough energy for those two things. Secondly, to that, your body needs enough carbohydrate availability. So what does that mean? It’s not just how much fuel you’re getting in, but also the like, the amount or the percentage of that that is from carbohydrates. And we know we need to be at least a 50 to 60% of our total intake needs to be from carbohydrates. That’s important to make sure that our body is running on its preferred fuel source. That is also helpful for high intensity exercise. It basically. Blunts the cortisol response of high intensity exercise. If we have adequate carbohydrates available and it helps us post-exercise with recovery, so replenishing our glycogen stores and making sure that we kickstart that protein synthesis process, we need carbohydrates, not just protein for that.
Sarah Liz King (00:13:03) – So what does this look like? This looks like making sure that you have a solid pre training snack or meal and a post-training snack or meal depending on where in the day you’re exercising. If you’re like, Sara, exercise first thing in the morning, there is absolutely no way that I can eat before I train. I’m going to say, sure there is. You can figure it out, but it’s a little bit of trial and error to figure out what you’re going to eat that’s going to sit well with your body. But hands down, none of the people I work with have ever kind of tried something out and never found anything that works for them. It’s about kind of being open to the fact that, yeah, your body’s going to have to get used to having a little bit of fuel in your stomach, but it’s not going to be so much that it’ll be really uncomfortable and hinder your workout. If anything, it’s only going to benefit your training. So mostly what you need before you train is just carbohydrates.
Sarah Liz King (00:13:56) – They can be easily digestible. That’s kind of what’s preferred, so that it doesn’t take a long time for your body to get that energy. My kind of recommendations for things first thing in the morning could just be like a big glass of juice, could be some dates. So there’s like big medjool dates, a few of those depending on how much you’re doing. Toast, banana and honey. That is like my favorite or a bowl of like low fiber cereal just with some milk. All of those will get you a little bit of fuel in the tank to go and do your workout and also help kickstart that recovery process afterwards. And again. Recovery, nutrition, pre-workout, nutrition. It is a science. It’s been very well studied. If we want to kickstart that protein synthesis process after our workout. We need two things. Obviously, the stimulus, which is the training that we’re doing. The second thing is a mixture of proteins and carbohydrates. Ideally in that kind of 3 to 1 to 2 to 1 ratio.
Sarah Liz King (00:14:54) – So that means more carbs than protein. So some really great examples if you’re having like maybe a post-workout snack as opposed to a post-workout meal, things like chocolate milk, you know, dairy has a really high leucine factor. Leucine is helpful in maximally stimulating protein synthesis. You want to be really sciency or it could be things like maybe you’re just normal breakfast that could be overnight oats or eggs on toast or something like that. But it needs to be really, really nourishing. And if you are adding more exercise in, you also have to adjust how much you’re eating in the rest of the day. So making sure that you’re getting enough energy overall so that your body can continue to function normally as the day goes on. So this is where it would be really, really helpful to work with a sports dietitian or a sports nutritionist, especially if you have a specific goal in mind for the kind of training that you want to return back to. And also they can help you achieve any performance related goals once you’ve gotten back to that stage of.
Sarah Liz King (00:15:56) – Whatever volume or kind of exercise you want to be doing. So really, really helpful to kind of get that knowledge and expertise from a health professional. But in the starting points, we just need to be making sure that we have that pre workout nutrition 30 to 60 minutes before we hit the gym and that post-workout fuel around to help kickstart that recovery process as well. So our body doesn’t sense exercise as a form of stress when we do it. The one other thing I will add in about kind of recovery nutrition specifically, if you are a person that’s like, I really want to build more muscle and move back into strength training is that we want to prioritize protein but not put it on a pedestal and go like, I only need protein and nothing else. Prioritizing protein just means being mindfully aware of including protein rich foods throughout your day, right? It’s not saying like, Oh my God, if I only have like toast that my muscles are going to fall off. No, but you can use your snack opportunities to include protein rich foods.
Sarah Liz King (00:17:00) – So things like protein, yogurt or protein powder. In combination with other things. I wouldn’t say to someone, just go and have a protein yogurt. I would be like, have a protein yogurt with some like fruit and granola or use the protein powder to make a smoothie. Because in terms of our protein needs, they do increase with the more intense exercise we do and a higher volume of exercise that we do. So there are around 1.5 to kind of like 2.2g of protein per kilo of body weight per day. Again, I give you those as a reference. I don’t think it’s necessary to kind of like crunch your numbers every day. Don’t recommend calorie counting or anything like that, but you can be mindful about like going and going, Oh, that’s like roughly this amount. So I probably need, you know, a decent sized protein serving at my main meals and I could kind of have these snacks in addition to help me hit the rough guide of whatever my protein target is per day. But you can still eat very intuitively and hit your protein and energy requirements if you’re mindful of kind of what you look like and what that looks like for you.
Sarah Liz King (00:18:05) – Which is why, again, working with a sports nutritionist or sports dietitian can help because they can kind of go this amount or this amount you need looks like X, Y and Z in a day, and they can give you those examples in real food form instead of you having to like crunch the numbers and calorie count and weigh things. We don’t want to go back to that because if it’s a habit you’ve likely given up in the past, you don’t need to pick it up now. So that is a non-negotiable if you want to train hard again, another non-negotiable is prioritizing rest and recovery. If you want to train hard, you also need to make time for recovery and rest. In the simplest form. Kind of means 7 to 8 hours of sleep most nights, and also paying attention to and addressing any like niggles or soreness that you have that seems out of the ordinary modifying exercise during times of stress so that you don’t overwork yourself and burn yourself out and essentially like get yourself into another bout of hypothalamic amenorrhea, which we don’t want.
Sarah Liz King (00:19:09) – Personally, I think we need to adopt a less is more mentality. Like I’m an exercise physiologist by trade and obviously we learn the science of like what is the most beneficial, but it doesn’t mean it’s the same for every single person. And just because you can do more exercise doesn’t mean you should. You need to or you have to. I always talk about the minimally effective dose, right? If we have a specific goal in mind, what is the minimally effective dose that we can put our body under or we can stress our body because obviously the stress is what prompts the adaptation. So the stress of, you know, progressive overload training is what prompts us to go through the process of protein synthesis and lay down more muscle. The stress of increasing endurance exercise over time is what builds our cardiovascular capacity. But we also have to be mindful that that doesn’t mean that we need to do the most to get that benefit. We can start with smaller amounts and increase it over time to a sustainable level, right? If you are not an athlete, if your job isn’t to perform, why do you need to be, you know, pushing yourself to the limits every single day? You don’t.
Sarah Liz King (00:20:24) – You don’t. So minimally effective dose could look like a health professional like me. Looking at your training and going, We don’t need to do five days a week in the gym. You could do 2 to 3 really well structured training sessions, rest a lot in between and you will get so much stronger as a result of that. Okay. So know that there is a point of diminishing returns. Doing more doesn’t necessarily mean better outcomes. Take the less is more mentality and make sure that you prioritize rest both on a daily basis and also rest by taking rest days every single week. So you have days of training and days off where you’re just kind of living your life and not doing anything. Another non-negotiable if you want to train hard is intentional time off and do loads. So the last thing when it comes to training hard is knowing that you can’t train hard all the time, nor do you need to, right? You need to period. Your training period as your training is different from periods. It’s basically.
Sarah Liz King (00:21:28) – Having blocks of training where you focus on progression and then you have blocks of training where you are simply maintaining and then you have blocks of training where you are working really lightly so that your body recovers. That’s kind of what period is that period in your training looks like. So when you learn it at uni, you learn things like micro cycles and mes cycles and macro cycles, and it’s designed to help a person get to their peak performance for an event through going through some of these different blocks of training where they’re maintaining, progressing, pulling back and then it kind of goes through the same cycle again so that they get to that event or whatever they’re preparing for and their body is at their peak while minimizing injury and illness. Now there’s a lot of science that goes into that, but having someone outside of your little brain modify your training and also prescribe your own personalised exercise program takes all of the guesswork out of that. There’s a reason why exercise physiologist and very well qualified personal trainers exist is that we know all of the science and the formulas and what you should be doing and how hard you should be pushing and when you should be pulling back.
Sarah Liz King (00:22:45) – And we tell you why it’s important and when you should be doing it based on how your training is progressing, how your body feels, what you have going on in your life so that you can always feel good when you show up to your training. Now, if you’re like, Sara, that sounds great. I would love to have someone take the guesswork out of it and do like a personalized prescribe program, but I can’t afford it. Then my general rule of thumb is that you should be doing at least a download every 4 to 6 weeks, which means you take at least 50% of your load off, 50% of your volume off whatever kind of training you’re doing, and just have a week where you kind of like allow your body to reset, allow your nervous system to down regulate before you go into your next block of training. And it could also be intentional time off during the year. And I think this is really important just for us to get to. In general, having a healthy relationship with exercise means knowing that you could have a weekend away, take a holiday right on.
Sarah Liz King (00:23:46) – Like, not that I’m wishing this upon anyone, but have an injury occur and not feel like it’s going to stress you out because you can’t do your normal exercise routine. Intentional time off shows us exercise is a nice to have. It definitely benefits our health in so many different ways, but we can function and fuel ourselves even if it’s not there, right? Whether that be for a holiday or the unfortunate occasion when, you know an injury or an illness does happen. So if you want to train hard, you have to prioritize your training, have some downloads, take some intentional time off so that your body has moments where it’s stress, but also moments where it can recover because it has that time to work on repairing and restoring so that when you show up to your next workout, your next block of training, you’re feeling really fresh. And that’s how you should be feeling with your training. So that’s the long answer to the question. Can I ever train hard again if I have had hypothalamic amenorrhea in the past? The answer is yes.
Sarah Liz King (00:24:52) – But you need to make sure your estrogen levels are sufficient. You need to make sure that you are prioritizing your pre and post workout nutrition. You need to gradually increase your exercise and then within that you need to be planning rests, rest periods, time off and do loads. If you’re doing all of that, there’s no reason why you can’t train hard and enjoy all of the different kinds of exercise that you used to love before your body can handle it. You just have to give it the environment in which it can thrive, not, I guess, push it to its limits, which you might have been doing before. Now, that’s the answer to that question. We’re going to go back to the beginning where I mentioned a few other questions, one of which is will I ever safely be able to lose weight or pursue body composition changes if I have had hypothalamic amenorrhea in the past? Now, I have specifically done an episode with Talia Chocolate, another dietitian on this topic specifically, and I am going to link it below in the show notes so that you can listen to that one because it more comprehensively discusses that topic in in more detail.
Sarah Liz King (00:26:04) – So that would be my recommendation. I’m not going to go into it on here, but I’m going to give you that that link in the show notes. Will I ever be able to resume endurance exercise like long distance running again? The answer is yes, so long as you are taking into consideration everything that I just mentioned into this podcast. And I would highly recommend both working with an exercise physiologist or a running coach alongside a sports dietician to make sure that, you know, when you start to reintegrate that endurance exercise back in, you’re doing it in a really healthy way. Your body’s well fueled, you’re recovering well, you’re not impacted by stress injuries, and that’ll make sure and obviously your periods stay regular. That’ll make sure that you kind of holding yourself in good stead and you might not need those health professionals forever, but it’s really helpful, especially in those first 12 months, to have some support and guidance. And the last question is how will I know if I’m pushing too hard or putting myself at risk of losing my period when I start increasing exercise again? Now, there’s no crystal ball that we have that is going to say when you increase exercise, you’ll be safe and fine and your body will function perfectly or you’ll run the risk of losing your period again.
Sarah Liz King (00:27:19) – But some of the red flags that you can look out for are poor recovery from your sessions. So you’re feeling really sore, really fatigued, really, really low on energy. You’re not sleeping well. You’re noticing any of those kind of hypothalamic amenorrhea signs and symptoms that you were before. So vaginal dryness, if you like, cold all the time, low libido, moodiness, all of those kinds of things can be signs that you’re pushing too hard. Again, losing. All the cervical mucus that you’ve had, that’s a really big red flag. That kind of things are going a little bit too far. You’re getting inconsistent with your eating, so you’re not prioritizing that pre and post workout nutrition and also you’re not getting enough energy in throughout the day like you’re just not making it a priority. Those can all be signs that you might be pushing too hard. So it’s both from a physical point of view, feeling really tired, feeling really under recovered from your workouts, not looking forward to them, not seeing any progress with what you’re doing, as well as kind of those old signs and symptoms to look out for.
Sarah Liz King (00:28:23) – And the best way to avoid that ever happening again is to follow all of the things that I said today and tick all of those boxes before you start increasing the intensity and the amount of exercise that you are doing. Because, yes, you can get back to a stage of life where you are pushing your body, but you’re also giving it the space and time to recoup recover so that next time your performance increases again. And if you want any guidance and support on personalized exercise prescription, you can check out our BT program, click the link in the show notes. BT stands for Better Balance Training. It is our online personal training platform for strength training for individuals that have had a history of in the past, or they just want to get strong without all the diet culture. So jump on a discovery call and we could definitely help you out with that. Until then, keep looking after yourselves and I will be back next week with a fresh new episode you could wrap your ears around.
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