hypothalamic amenorrhea

Real health #20 Why your period is so important for your health

It’s been a while since I talked about my favourite topic.. the menstrual cycle aka your period. Specifically why your period is important for your overall health and the problems associated with not having a regular menstrual cycle. Any guys out there, maybe this isn’t the article for you but feel free to read on and you could just learn something to help the ladies in your life!

We usually think of our menstrual cycle as two phases: bleeding and not bleeding. In reality it is a menstrual cycle with levels of several reproductive hormones shifting throughout the month. The amount of these hormones your body produces is sensitive to stress, including both physical stress from under-eating and over-exercising and mental and emotional stress. When you lose your period because something is off in your lifestyle is it called Hypothalamic Amenorrhea (HA). I wrote all about this in a previous post so you can check that out if you are interested in learning more. But here I want to focus on the problems that come with not having your period.

The problems with not having a period

The most obvious reason to have a regular, healthy period is of course your fertility. The whole point of your menstrual cycle is to prepare your body for pregnancy and allow you to have a baby. If you don’t have your period, it’s very unlikely you are going to be able to get pregnant. But what if you have decided you don’t want children or you’ve already had children? It’s still important for you to have your period too! I spent many years believing it was “fine” that I didn’t have my period and it was actually pretty convenient to be honest, not to have to buy tampons, worry about getting pregnant or have my period ruining my plans but once I found out what it means to not have a period and how unhealthy it is for your body I was shocked and I wished I’d been told sooner.

One of the key hormones that drives your menstrual cycle is estrogen. Apart from it’s role in your menstrual cycle, did you know that estrogen also helps to build your bones? When women enter the menopause and stop producing estrogen they start to lose bone mineral density and are at an increased risk of developing osteoporosis or brittle bones. Not having a regular period is a sign that your hormone balance is off and estrogen levels could be low. Girls who don’t have their period due to hypothalamic amenorrhea during their teenage years are at risk of developing early onset osteopenia which can lead to osteoporosis if not treated. This might not mean much when you are young but trust me, you want to make sure you are building strong bones while you can! And don’t forget that your if your bones are losing minerals then it’s highly likely that your teeth are suffering too putting you at increased risk of cavities and teeth sensitivity. Who thought that periods and teeth were related??

Another surprising link is between hypothalamic amenorrhea and heart disease. Estrogen has an anti-oxidative, anti-inflammatory effect in the body and also acts as a vasodilator meaning it causes your blood vessels to expand and low levels of estrogen have been linked with an increased risk of developing heart disease. Even though most of the research is in post-menopausal women, there have also been studies linking low estrogen levels in younger women with build up of plaque in the arteries and increased risk of heart disease in later life. And yes this is even for those who exercise! You might think you are being super healthy and boosting your cardio-vascular system but if you are exercising excessively and you have lost your period then you are undoing all of that hard work. Another thing I wish I’d known about sooner..

Other problems with hypothalamic amenorrhea

Not only does hypothalamic amenorrhea put you at risk for issues later in life, it can also cause problems in the here and now. Low estrogen can also be the explanation for fatigue, headaches, low sex drive, vaginal dryness, anxiety, depression and insomnia just to name a few. And as well as your reproductive hormones, not having your period could be a sign that other things are off in your body. We often think of our body systems acting in isolation but in reality, all of these things are connected and if one falls down it can have a domino effect throughout your body.

Often women with hypothalamic amenorrhea have higher levels of the stress hormone cortisol which also has been associated with bone loss as well as anxiety, insomnia and lower thyroid hormones. In hypothalamic amenorrhea, your metabolism is suppressed which could explain symptoms of hypo-thyroidism such as feeling cold all of the time, hair loss and low energy levels. Many women who develop hypothalamic amenorrhea due to restricting their food intake also experience digestive problems like bloating, stomach pain, constipation and food intolerances. If you don’t have your period and you feel like you are constantly struggling with digestive issues, then maybe the two could be related.

What should you do if you’ve lost your period?

So if you have made it to the end of this post, well done and I hope I didn’t scare you too much. If this is you, don’t worry, now you know you can do something about it! First you can read my blog posts about hypothalamic amenorrhea, how to recover and my recovery story. I’d also recommend buying the book No Period Now What by Nicola Rinaldi if you want an in depth explanation of all things hypothalamic amenorrhea related. If you need that final push to commit to getting your period back, definitely buy her book. If you think you have hypothalamic amenorrhea, visit your GP to get your hormone levels checked and Nicola also offers blood test results analysis through her website if you’re unsure. Three steps you can take right now:

  1. Eat more food and let go of any dietary rules and restrictions
  2. Take a break from intense exercise for at least a month
  3. Reduce the stress in your life and add more stress relieving activities

Easier said than done I know, but I believe in you! It’s never too late to recover your period and undo at least some of the damage to your body from hypothalamic amenorrhea. Recovery is challenging but so worth it.

References

Emma O’Donnell, Jack M. Goodman, Paula J. Harvey, Cardiovascular Consequences of Ovarian Disruption: A Focus on Functional Hypothalamic Amenorrhea in Physically Active Women, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 12, 1 December 2011, Pages 3638–3648, https://doi.org/10.1210/jc.2011-1223

Over to you…

I hope you enjoyed this article on why it’s important to have your period and the series so far. Let me know in the comments below your thoughts and experiences, I’d love to hear from you.

  • If you want to follow along with this Real Health January blog series, like this post and follow my blog for daily updates. And please share with anyone you think might be interested!
  • If you are looking for guidance, support and accountability on you health journey, please contact me for information on the nutrition and holistic health coaching packages I offer. I would love to work together with you to get you feeling your best again.

Other posts you might like

Shufelt, C. L., Torbati, T., & Dutra, E. (2017). Hypothalamic Amenorrhea and the Long-Term Health Consequences. Seminars in reproductive medicine35(3), 256–262. https://doi.org/10.1055/s-0037-1603581

cycling exercise during period recovery

Can exercise stop your period coming back? 5 ways exercise can slow recovery

A common question from women trying to recover from Hypothalamic Amenorrhea is “can I exercise while trying to get my period back?”. I wrote about my tips for exercising during HA recovery but if you are thinking about taking a break and need some motivation, here are 5 ways exercise can work against your recovery.

1.Exercise burns calories which could otherwise be directed towards healing and repair of damage caused by dieting. The point of eating a lot more food during recovery is to flood the body with energy and nutrients to use for healing and repair. Exercise burns up some of these precious resources which will only prolong the healing process. Often women find it hard to meet the minimum recommended calorie intake for recovery and if you choose to exercise you should eat even more to compensate which can be a challenge.

2. Many women use exercise as a way to compensate for “over-eating” and it can be temping to start to move more when we allow ourselves to eat in abundance. We don’t want to exchange one control mechanism for another, we want to be completely free of all restrictions and compensations around food. We want to get to a place where we let go of any toxic beliefs around exercise and let go of guilt for resting. Exercising to make up for eating more is just another form of disordered eating behaviour.

3. Intense exercise is perceived as a stress by our hypothalamus, the brain master control centre. This means it can continue to feel it is unsafe to reproduce and not send the signal to restart our cycles. Although exercise is a good way to relieve mental stress, it is a physical stress on the body as it depletes glycogen reserves, increases the heart rate and damages muscle tissue. Exercise is healthy for a healthy body but if you don’t have your period you are not healthy right now and rest and recuperation will be your medicine.

4. For many women with HA, exercise has long been used as a way to manipulate their body and separating exercise from weight loss is difficult. We want to get to the point were we can exercise for fun and well being, regardless of the impact that it has on our physical appearance. If we continue to exercise during recovery, we might not do some of the mental work that is needed to fully break free of the weight loss mindset. It’s likely that you need to gain weight if you have lost your period and exercising could make this more difficult.

5. Exercise can be used as an appetite suppressant or a distraction from hunger. Exercise puts our nervous system in “fight or flight” mode when our body is stimulated and running on adrenaline which decreases hunger. You might find that you are more hungry on rest days because your body has calmed down and this is exactly what we want for healing. If you are hungry on a physical or mental level you should eat. Don’t fall into the trap of being “too busy to eat” as this will only delay your recovery.

Once you have recovered your period and have accepted your healed body, you might want to start exercising again from a much better headspace but at least it will be a conscious choice rather than because you feel you have to control your body in some way.

Over to you…

I hope this article gave you something to think about! It’s a personal choice whether you decide to stop exercising all together during your recovery. Women have recovered successfully from HA whilst still exercising but it is my opinion that we recover faster and more completely if we give our bodies chance to rest and fully repair.

  • Let me know in the comments, how do you feel about taking a break from exercise? Does it feel scary or a relief? For those in recovery, are you still exercising or taking a break?
  • If you are looking for support, guidance and accountability on your period recovery journey, please contact me for further information on the health coaching packages I offer. Together we will set you up with a plan to get your hormones balanced and you feeing your best mentally and physically.

Other posts you might like

exercise and hypothalamic amenorrhea

What is Hypothalamic Amenorrhea? Why have my periods stopped?

What is Hypothalamic Amenorrhea?

Hypothalamic Amenorrhea (HA) or Functional Hypothalamic Amenorrhea (FHA) is when a woman has no period for 6 months in a row or more, despite having no anatomical or disease-related reason for lack of menstruation. Functional means behaviour related and we will come to what those behaviours might be later in this post.

Primary vs. Secondary Amenorrhea

Amenorrhea is the medical term for missing periods or the absence of a menstrual cycle. HA and FHA are known as secondary amenorrhea, which is when a woman’s periods have stopped or she has missed several periods in a row. Primary amenorrhea is when a woman has reached reproductive age (usually considered to be 15 or 16) and her periods have not yet started. Primary amenorrhea can be due to genetic conditions affecting the ovaries, hormonal issues relating to the pituitary or hypothalamus glands or structural problems with the reproductive system. The most common causes of secondary amenorrhea are pregnancy, breast-feeding and menopause but it can also be due to birth control methods such as the contraceptive pill or implant as well as functional conditions such as Hypothalamic Amenorrhea.

Hypothalamic Amenorrhea symptoms

Aside from missing periods, there are many other symptoms which can occur with Hypothalamic Amenorrhea. I have listed some examples below although not all (or even any!) of these symptoms have to be present and every woman’s body is different.

  • Thinning hair or hair loss
  • Feeling cold, especially cold hands and feet
  • Excessive tiredness or low energy
  • Anxiety and depression
  • Low sex drive or no libido
  • Abnormal appetite
  • Low bone density or osteopenia

Hypothalamic Amenorrhea explained

**If you aren’t interested in the science-y part then feel free to skip to the next section!

Hypothalamic refers to the hypothalamus, an area of the brain sometimes called the “master controller”. The hypothalamus has many functions, the main ones being regulating hormone levels and maintaining stable conditions inside the body including temperature, blood pressure and appetite. It does this sending out correcting signals responding to changes in internal and external factors.

One of these signals relevant to HA is the release of Gonadotropin-releasing hormone (GnRH) which causes another gland, the pituitary to release Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH) which are responsible for maturing a follicle in the ovaries and releasing it in ovulation which is the main event in the menstrual cycle. Watch the short video below if you want to learn more about how the hypothalamus and pituitary glands work together.

The ovaries are the reproductive organs which release the sex-hormones estrogen and testosterone which also play a role in regulating the menstrual cycle. The hypothalamus and the pituitary are connected to the ovaries along what is called the Hypothalamic-Pituitary-Ovarian (HPO) axis. In HA, there is disruption to the HPO axis due to some sort of stress on the body resulting in low levels of FSH, LH and estrogen. This means no ovulation and a missing period.

What causes Hypothalamic Amenorrhea?

There are several factors at play when it comes to missing periods:

  • Under eating, chronic or restrictive dieting or poor nutrition
  • Over-exercise, especially endurance sports
  • Low body weight or rapid/extreme weight loss
  • Stress and excessive worry

The typical woman suffering from HA is a type-A personality and over-achiever in all areas of life. Especially when this perfectionism extends to diet, exercise and body weight. Extreme examples are women who are constantly on a diet, restricting calories or types of foods and go running 7 days a week. Those who maintain a very low weight even though they are fighting against their body to stay there. Or women who work or study long hours expecting nothing but the best from themselves at all times.

But HA can also affect women in less extreme circumstances who might have lost weight in a “healthy” way or who have been accidently under-fueling over a long period of time (I’m talking to you busy working mums!). Or women who have gone through a stressful life transition. Basically our bodies are trying to keep us safe and alive by conserving calories during a stressful time.

Treatment for Hypothalamic Amenorrhea

There has been a steady increase in the number of searches for “how to get my period back” over the last 10 years. In the case of HA recovery the formula is pretty simple!

EAT REST RELAX REPEAT

  1. Eat plenty of food and I’m talking a surplus of calories
  2. Let go of any diet restrictions and consume all food groups
  3. Take a break from intense exercise
  4. Rest or focus on low intensity movement such as light yoga
  5. Remove as many stressors from your life as possible
  6. Take time to relax and de-stress every day
  7. Consider therapy to help with making the changes above if they feel challenging

Over to you…

I hope this article helped you to better understand HA and why your periods might have stopped. If you want to read more on how to get your period back and recover from Hypothalamic Amenorrhea, check out the posts linked below. Like this post and follow my blog for more like this!

  • Let me know in the comments, what is the most difficult part of the recovery formula for you?
  • If you are looking for support, guidance and accountability on your period recovery journey, please contact me for further information on the nutrition and health coaching packages I offer. Together we will set you up with a plan to get your hormones balanced and you feeing your best mentally and physically.

Other posts you might like


Information sources

Gibson S, Fleming N, Zuijdwijk C, Dumont T. Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea. J Clin Res Pediatr Endocrinol. 2020;12(Suppl 1):18-27. doi:10.4274/jcrpe.galenos.2019.2019.S0178