What to do when your period goes MIA: Healing Hypothalamic Amenorrhea
Hypothalamic Amenorrhea...It’s the medical term for an AWOL period.
A LOT of us chronic dieters have been here before, having our period go missing in a season of over exercising and under eating...OR, more widely understood, it can happen when we go chasing after the unrealistic standard of thinness presented to us in society.
HA happens for one reason and one reason only: STRESS.
So much stress that the body perceives its threatened state as UNFIT for childbearing and the hypothalamus sends the signal to the rest of the body to shut down reproductive function, therefore cutting off Aunt Flo.
In so many terms, women lose their period because of an imbalance of ENERGY: Too much energy going OUT, not enough coming IN.
Energy OUT > Energy IN --> Hypothalamic Amenorrhea
The outgoing energy is essentially STRESS of any kind. But the MOST COMMON in HA can be categorized into these three things:
Calorie deficiency/ macro deficiency
And in MOST cases, all three are present. Often we see a restrictive eater eating under 2000 calories a day because that’s what ‘SHAPE’ told her, hitting the gym 5x a week, and battling negative body image/low self-worth on the daily.
I’ve been there, and I see COUNTLESS women there too.
The truth is, if your period has gone missing, something you’re doing is NOT SERVING YOU: eating, exercise, toxic relationships, etc. It’s time to take stock and figure out which it is. One of the biggest mistakes I see is women being told it’s OKAY for them to not have a period. Most doctors will tell you not to worry about it unless you are trying to get pregnant, or they’ll give you a prescription for The Pill and send you on your way.
In reality, having a regular consistent cycle naturally is the BEST way to ensure healthy reproductive function. And When that goes awry, it is also one of the quickest and easiest ways the body tells you something is off, and we need to pay attention.
Why you want to LEAVE me?
*if anyone got that My Big Fat Greek Reference there, bravo. For the rest of you…stop what you’re doing and watch it right now.
As I mentioned before, your period will go missing because your body’s stress levels rise too high to be able to sustain reproductive function. This has to do with a process called the pregnenalone steal, which I talk about more in depth in my post on stress HERE.
The main points are this: since your body will always prioritize survival over baby making, its resources will ALWAYS—I repeat, ALWAYS- go to filling the demands of cortisol production over sex hormone production if the need to choose arises. So, in times when our body senses a threat in the form of famine, emotional trauma, too much physical exertion, etc, it’s need for cortisol goes through the roof. And if we don’t provide our body with enough food and raw materials to keep up with the sudden demand for hormone production, sex hormones will get put to the back burner.
Which, then, leaves us with a cycle edition of hide-and-go-seek.
The three most common stressors we see in women of childbearing age connected to HA are
Not eating enough
Before you say ‘yeah…none of that is me..I’m not that stressed’..let’s dig a little more into specific examples of what that can look like and how awfully widespread they really are!
3 PRIMARY CAUSES OF HA
1. Not eating enough:
This is, hands down, the MOST present in cases of HA. This is MOSTLY due to the fact that the constant obsession with chronic dieting has left half the population MASSIVELY under fed chronically. And, not to mention, it has also spread wrongful information about exactly HOW MUCH is enough for an average young woman. They think 1600 calories is sufficient for a young active woman to maintain hormonal function because that is the number we see spouted in diet and ‘health’ magazines all across the country.
Here’s the problem: almost all sources of health information you are looking to have weight LOSS as the number one priority. NOT getting your period back.
AND, if you’re period is missing, chances are it was that exact long time shrinking pursuit that caused it to go missing in the first place, so the information and recommendations they share aren’t helpful! (to be honest, they rarely are *insert shrug emoji*)
Caloric deficits are not the only deficits that are seen in HA cases. Macronutrient deficits are a big one as well. Primarily we see women eating too low FAT or low CARB, OR BOTH (double whammy). This is a big no-no for reproductive function because 1) Fats are what our body actually USES to MAKE hormones. So skimping on things like avocados, olive oil, coconut, nuts, and fatty cuts of meat won’t provide your body the resources it needs to produce things like progesterone and estrogen, ESPECIALLY in times of stress when what little resources you have will be shunted to make cortisol. And 2) Under eating carbs, ESPECIALLY when active, means you don’t secrete enough amylase in the saliva. Amylase is the unique salivary enzyme secreted in response to starches that communicates to your pituitary gland that you have enough food in the environment. This is because evolutionarily speaking, carbs and starches were a sign of plush vegetation and an abundance of food. It was safety. Carbs ALSO provide the critical glucose your thyroid needs to convert T4--> active T3, which allows the rest of our metabolism and cycle to run smoothly.
This is why for the majority of women I recommend an abundance of BOTH dietary fat AND carbohydrates because they each play a specific and critical role in hormone health, but ESPECIALLY in healing from HA.
*note, if you saw my KETO post on insta recently, you know I mentioned how dangerous it can be for those who DON’T have a specific medical reason for it. There is a time and place for low carb in the medical world, but weight loss isn’t one of them. And if you’re period is missing, carbs are going to be CRITICAL in the process to get them back!
Too much time spent in the gym or on runs is another vital reason why your period goes missing. This interacts MAJORLY with cause number 1 because it depends on whether you’ve been exercising too much IN RELATION to how much you’re eating, and also what your other stressors are like in other areas of your life. Activity increases your need for calories, so if you’ve been under eating calories in an effort to stay or get thin, then your body’s need for increased food hasn’t been met. That signals the starvation alarm in your body and sends cortisol through the roof.
This is so important to realize because often women won’t acknowledge that their exercise could be a contributing factor to their HA.
‘I only exercise 3-4x a week though!’
‘I do less than my neighbor and SHE has her period! It can’t be that’
We forget that exercise is a stressor, something that raises cortisol in of itself, and so if you add workouts ONTOP of an already stressed system (like one that is restricting her calories or going through a really stressful season at work), that is a recipe for disaster. It ALL contributes to your overall stress load that builds to your own INDIVIDUAL limit. Not your neighbors, not your sisters, YOURS. And if your period went missing, that’s a sign your limit was met and surpassed.
3. Emotional/Mental stress
There are so many contributors to our emotional stress that can mess with our cycles. A lot of us have already experienced this in the short term when a stressful month or week caused our period to come late.
In my senior year of college, I had my heaviest work load yet and I was STRESSIN for finals week. My period was supposed to come on Monday, but didn’t end up showing up until Friday afternoon within the HOUR that I finished my last exam and I could finally breathe with relief.
Our bodies, especially our hormonal systems as women, are CRAZY in tune with our emotional and mental state. Toxic relationships, emotional trauma, loss, work stress, too much screen time, and negative body image all contribute to that stress load I mentioned earlier and communicate to our brain that it is NOT a good time to be making a baby.
In today’s world, it is so easy to normalize the amount of stress we are under. But the truth is, we have to be INTENTIONAL about stress relief, setting boundaries, and balance in this world if we want to maintain a semblance of peace in this busy, comparison obsessed age. *to learn more about how stress impacts your health and 10 ways to lower cortisol, read my post HERE
BABY, COME BACK
This is what you've been waiting for! Here are my Top 5 steps to getting Aunt Flo to come back home:
1. Eat more, often, and fully
When getting your period back, it is CRITICAL to provide your body with MORE than enough food of EACH macronutrient (yes, I said MORE than enough). This is because the priority is to communicate to your brain that your body is SAFE, and the best way to do that is through regular feedings with absolutely NO restriction of any kind (fat or carbohydrates). Yes, optimizing nutrient density is helpful for all walks of life and hormone situations, but it’s important to realize that feeling mentally restricted around certain foods like cake or pizza is an excess stressor you PARTICULARLY don’t need when healing HA. Get your veggies in but get rid of your food rules. They don’t serve you, and unless you have a medical reason for removing an entire food group, then there is no reason to avoid it when doing so causes you to feel deprived.
Some easy tips for remaining well fed are:
Eat breakfast within 30 minutes of waking if possible
Breakfast should be Large and include all 3 macronutrients: protein, fat, and carbs
don’t go hungry, or push through hunger. If you feel REMOTELY hungry, eat immediately
don’t skip meals, and include snacks
include ALL three macronutrients at every meal, and snack if possible
Hit a MINIMUM of 2000-2500 calories daily.I repeat, MINIMUM, which means this is the absolutely LOWEST you can go while healing HA. Though some don’t need to count ever, it is helpful for some women to count for a couple days just so they see what 2500 calories of food looks like if they have been significantly under eating for so long. We don’t want to be estimating if our estimations keep us UNDER that.
*if that calorie minimum made your jaw drop to the floor you’re not alone.
Even though there ARE exceptions to this rule, considering you’re reading this and hoping to get your period back, I’m just going to go out on a limb here and say you are NOT one of the exceptions. Up your calories and use this as a minimum for all functioning. If you are active at all, walk to work, breastfeeding, trying to get pregnant or already are, etc, up them accordingly. The priority is safety and hormonal abundance, which is NOT the priority of the health magazines that are prescribing 1600 calories for weightloss!
I want you to think of food as SAFETY to the body. It is better to err on the side of eating more than less with HA, because more food will just serve to assure your body that you are in a land of plentiful resources, and it is safe. But eating LESS will alarm those stress and starvation signals, which is the OPPOSITE of what we want….Which brings me to my next point.
2.Gain safety weight
Being OKAY with gaining weight! Most-not all, but the MAJORITY- of women need to gain weight to get their period back. It is a common misconception that women need to get back to the weight they were when they lost their period first and then their body will get it back, but this isn’t true for a lot of us. Many women have to EXCEED the weight they were at when they lost their period in order to get it back. This has something to do with your ‘estrogen set point’. This refers to the individual level of estrogen in every body needed to maintain a menstrual cycle. NOTE: this is different for each woman AND can change in your life. One of the things that make it rise? Losing your period.
Once lost, your body will demand MORE estrogen before the cycle starts back up again. And since one of the biggest producers of estrogen is body fat, it is helpful to put on weight in order to get your period back.
If this terrifies you, I want you to dig into that. We as a society are very ‘fat-phobic’, we demonize body fat and call it ‘gross’ and ‘unhealthy’. In REALITY, body fat is a NECESSARY part of the human body, even more so for women’s health!! It is the pursuit of a fatless body that causes many hormone problems in women in the first place! Unpack that stigma around worth and weight so you can allow your body to fluctuate as it needs to be healthy without stifling it. If you need personal help on this journey, reach out to a coach to help you through it.
3. Cut back on movement-temporarily
I HIGHLY recommend cutting back movement and workouts, no matter what you are doing. Whether you’re hitting spin class every day or just lifting weights 3x a week. Whatever it is you are doing, it’s going to benefit to take a step back and reduce intensity and duration of your workouts. You can go all in and ONLY commit to doing gentle yoga and walks for 3 months if you want to get your period back ASAP, or you can titrate back more slowly if you are willing to be more patient. Either way, I HIGHLY recommend removing all HIIT and chronic cardio from your routine. Those can be too stressful on your system in a time when you are trying to be as stress-free as possible. *Remember that this is TEMPORARY, as we want to be EXTRA cautious when healing HA. (Although, whether you have HA or not, chronic cardio is not optimal for hormone health. I detail why HERE)
4. Reprioritize your life
HA can sometimes serve as the necessary wakeup call a lot of us need to realize that we CAN'T run ourselves into the ground all the time. If you are serious about getting your period back, take this time as an opportunity to focus on what matters, and rid yourself of anything that doesn’t. Stop over exerting your commitments, ask for help, and make your mental health the top priority. If you are coping with emotional trauma and loss, start seeing a therapist to help you through that. If you are battling chronic body image issues and food anxiety, seek help and shift your priorities to starting the path to self-acceptance. As a woman in this world we can be overtaken with all the pressures and unrealistic standards thrown at us, it takes INTENTIONAL rebellion to live a life where you are happy with who you are and how you look. Make that intention, because you are worth loving, especially by yourself.
At the end of the day, the MOST important thing is to be patient with yourself and have GRACE! A lot of women make the mistake of trying everything I mentioned for one month and expecting their period to come back right then. That RARELY is the case. Stick to this for 3 cycles MINIMUM! More if you went without a period for over a year. Healing the relationship with your body in HA is much like rebuilding trust with a lover that once betrayed you. Time and consistently meeting her needs is the only way she’s going to feel safe again.
Have you ever lost your period? What was going on in your season of life at that time? Chronic dieting? Stressful deadline at work? Eating disorder? Comment below and let me know!