Understanding Hypothalamic Amenorrhea: A Comprehensive Guide to Recovery

Written by Shannon Western, Registered Nutritionist, ACCPH therapist, and founder of Ease Nutrition Therapy.

What is hypothalamic amenorrhea?

Hypothalamic amenorrhea (HA) is when someone's menstrual cycle disappears. It’s caused by the body feeling unsafe to become pregnant, and so halts this part of the reproductive system.

The physiology behind HA (Hypothalamic amenorrhea) occurs when periods stop due to disruptions in the hypothalamus, a crucial part of the brain.

Factors like high physical activity, high stress levels, losing weight, or being at a low body weight can impact the hypothalamus. This halts the release of hormones responsible for the menstrual cycle. HA “shows” as a missing period. But the root cause is actually a lack of ovulation, due to this disruption in the
hypothalamus.

Simply put, if the body is under a lot of stress, your brain decides to hit pause on the menstrual cycle. The body becomes stressed also from many disordered eating behaviours - like limiting carbohydrates or fats, making up for food by exercising, and exercising when you’re exhausted.

Signs and symptoms

It's essential to recognise that this condition is not solely about missing periods; it is an indicator of an underlying issue. HA is often associated with hormonal imbalances, and it can have various causes, such as low food intake, stress, and over-exercise.

Understanding the signs and symptoms of HA is crucial for early detection and intervention.
Some common signs to watch out for include:

• Missing periods and ovulation
• Low energy levels - feeling like you have no energy at the end of the day
• Mood disturbances and swings
• Decreased bone density, injuries, sore muscles
• Feeling cold
• Disrupted sleep pattern and never feeling fully rested

How do you get a diagnosis?

Diagnosing HA involves a thorough evaluation of medical history, hormonal blood tests, and bone density scans. The tricky part is that signs of HA are signs of other conditions, especially PCOS. Since HA is so linked with relationships with food and exercise, it’s important to be honest about any disordered eating to ensure an accurate diagnosis.

How to heal your hypothalamic amenorrhea

Recovery from HA is a multifaceted process. It is not just about restoring regular menstrual cycles but addressing the root causes that led to HA in the first place. Recovery from hypothalamic amenorrhea involves:

• Regaining a healthy menstrual cycle
• Restoring hormonal balance
• Improving bone health
• Enhancing overall well-being
• Improving your relationship with food, exercise, and body

Recovering from HA requires a holistic approach. Nutrition for hypothalamic amenorrhea recovery:

1. Regular and adequate eating: This is the foundation of HA recovery, and for healing your relationship with food too. This looks like (at a minimum):

• 3 meals (and 3 snacks if required) everyday, with meals no more than 3-4 hours apart.
• Enough carbohydrates and fats: The hypothalamic requires enough of both to
  function properly.
• Plus when you have HA, you are in an energy deficit and so
  you need additional fuel to make up for this.

It’s very likely that this seems too much, especially if you’re still engaging in disordered eating. You can start slowly and build up, or work with a HA specialist to support you.

2. Exercise modifications:

• Exercise intensity: Reducing intense workouts and focusing on gentle forms of movement can help the body recover without added stress. This might mean swapping HIIT workouts for walks.
• Exercise schedule: It may be that you have to reduce from five days per week to two days of exercise per week.

For some, recovering your period might mean completely pausing exercising all together, or only engaging in very low intensity movement. It all depends on how your body responds.

3. Stress management for HA:

• Techniques such as mindfulness, meditation, and relaxation exercises into your daily routine are essential. Over time this helps lets the body know that it’s safe, and can resume the menstrual cycle.

• New strategies: It’s common in those with HA to have used food and exercise to cope with difficulties in the past. Such as controlling food more or over-exercising to deal with stress or life events. HA recovery is a wonderful time to develop new coping tools.

4. Weight restoring: 

• HA affects people at all body sizes, not just those in small bodies.
  Achieving a healthy weight for you is a significant part of HA recovery. This doesn’t mean based on BMI, it means based on what is healthy for your individual body.

5. Professional support: 

• If 1-1 support is accessible, this may be the best option for supported and guided recovery of HA.

Resources for hypothalamic amenorrhea

Recovering from HA can be challenging, but you're not alone. There are some valuable resources to support you, including:

1. The book "No Period. Now What?" by Dr Nicola Rinaldi. This is an excellent and highly praised resource, it’s definitely worth reading and implementing.
2.  The Ease With Food Podcast is a disordered eating recovery podcast that focuses on healthy relationships with food. It often has episodes on HA recovery in a holistic and realistic way.

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This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of Healf