period importance + hypothalamic amenorrhea
A healthy and regular menstrual cycle is crucial to female health. A woman’s menstrual cycle is a reproductive vital sign — its absence (premenopausal) is telling of underlying imbalances and stress.
Today, menstruation is often viewed negatively. Periods are seen as an inconvenience rather than the true sign of well-being, balance, and fertility that they are. Your period is not something to be ashamed of or feel embarrassed about — it is a sign of female health and fertility and absolutely necessary for your body to function optimally. It took losing my period for over three years to truly realize how grateful I should be to have it.
The absence of a menstrual period is known as amenorrhea. In this blog, I will discuss a form of secondary amenorrhea called hypothalamic amenorrhea (HA) or functional hypothalamic amenorrhea (FHA). I will also talk about the importance of a menstrual period, the causes and effects of HA, and ways to heal and support your menstrual cycle.
Period Importance
In the past, I struggled with disordered eating and over-exercising. As a consequence, I lost my period for over three years. At first, I didn’t think much about not having a period — it was simply one less thing to worry about. However, throughout those years, as I pushed myself through sports and neglected to fuel my body with adequate nutrition, I was the sickest I have ever been.
I experienced gut issues, skin problems, hair loss, intense anxiety, and brain fog, all while subjecting my body to internal deterioration and dysregulation. I did not understand that everything was connected, and my missing period was a sign of imbalance and dysfunction.
As I learned more about holistic and hormonal health, I began understanding the immense importance of the menstrual cycle and our hormones. I made changes to embrace my femininity and fully support and accept my body — I had to cultivate hormone balance so that I could heal and regain my menstrual period.
When I was younger, I had no idea what listening to and honoring my body looked like. I possessed no knowledge about hormone health, the four phases of the menstrual cycle, or cycle-syncing. There needs to be more education available for young women concerning their bodies and hormones. We must teach young women to embrace, appreciate, and honor their cycle. There is NOTHING wrong with having a period — it is a sign of balance, health, and fertility. Education and acceptance are vital.
What is amenorrhea?
Amenorrhea is the absence of a menstrual period. There are two main types of amenorrhea:
Primary amenorrhea: when you have never had your period — you have not had your period by 16 or within five years past puberty.
Secondary amenorrhea: when you have had a regular period, however, you stop having your period for more than three months. Hypothalamic amenorrhea is a type of secondary amenorrhea.
Hypothalamic Amenorrhea
Food and exercise are topics of trauma for many women. There is a lot of confusion and misinformation surrounding how we should eat and exercise. Often, this leads to emotional stress, undereating, over-exercising, and yo-yo dieting — all of which cause excess stress on the body and contribute to a decline in menstrual and overall health.
Chronic disordered eating and/or over-exercising leads to relative energy deficiency (inadequate energy intake in relation to energy output). This energy deficit is the primary driver of hypothalamic amenorrhea.
Hypothalamic amenorrhea (HA) or functional hypothalamic amenorrhea (FHA) is a common form of secondary amenorrhea. FHA affects about 1.62 million women between the ages of 18 and 44 years in the US and 17.4 million women worldwide. The cause of HA is related to both psychological (emotional) and physiological stress (undereating, eating disorders, over-exercising, etc.), which leads to the suppression of the hypothalamic-pituitary-ovarian (HPO) axis (system controlling female reproduction). There are three main types of HA: stress-induced, exercise-induced, and nutritional HA. The combination of these three is often at the root of a missing period.
How does HA halt the menstrual period?
Hypothalamic amenorrhea is a condition in which the brain’s hypothalamus causes menstruation to stop. The hypothalamus acts as the control center for several bodily processes, including the menstrual cycle. It receives messages (input about how we are eating, moving, thinking, etc) from the body and responds by signaling organs to secrete certain hormones.
When the hypothalamus receives a message that something is causing high levels of continuous stress on the body (psychological or physiological), it goes into survival mode. It directs the body to subdue less critical functions, such as reproduction, to conserve energy.
To halt reproduction, the hypothalamus stops secreting gonadotropin-releasing hormone (GnRH). GnRH is crucial to the menstrual cycle because it stimulates the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Together, these two hormones cause ovulation (the egg is released from the ovaries). Without GnRH, FSH and LH levels are insufficient for ovulation, and the menstrual cycle stops. This chain of events leads to hypothalamic amenorrhea.
Causes and effects of HA
HA is related to psychological stress (emotional), physiological stress (excessive exercise, under-eating, disordered eating, energy imbalance), or, commonly, a combination of these stressors. As stated before, hypothalamic amenorrhea is a survival mechanism (reaction to stress) used to conserve energy for the body.
A chronic energy deficit caused by undereating and over-exercising is a primary driver for HA. Contributing factors include restrictive eating, dieting, eating disorders (anorexia), weight loss, and over-exercising. Too little energy (calories) in relation to energy output signals to the hypothalamus that we are not safe and need to halt reproduction and downregulate sex hormones.
The absence of a period leads to hormonal imbalances, such as estrogen deficiency (hypoestrogenism). The loss of estrogen has detrimental effects on many systems throughout the body, including skeletal, cardiac, reproductive, and psychological systems. A compensatory increase in cortisol (stress hormone) production from the adrenals occurs in an energy deficit state; elevated cortisol concentrations contribute to numerous health complications.
Other factors, such as genetics, also contribute to HA. Every person is unique. Females are more or less susceptible to HA, depending on individual ancestry. As evolutionary biologist Grazyna Jasienska explained in her book Fragile Wisdom, this is called the ovarian set point. Essentially, we all require different amounts of energy from food to be able to ovulate — some females need more, and others do not require as much.
The main symptom of HA is a missing period for three months or longer; the hormone imbalances caused by this may lead to:
Depression and anxiety
Low energy and weakness
Sleep problems
Hair loss
Hunger (thinking about food all of the time)
Brain fog (trouble making decisions)
Skin problems
Headaches and dizziness
Low bone density (stress fractures)
Bradycardia (low heart rate)
Feeling cold all of the time
Low to non-existent libido
Gut and digestive problems (constipation)
Consequences of untreated and prolonged HA:
Reproductive health problems — atrophic changes in the muscles of the uterus
Neurocognitive status, emotion, and mood concerns
Impaired development of neuropsychiatric function
Bone health impairment —decreased bone strength and density + increased risk for injury
Changes in body composition
Often, women experiencing HA do not have bothersome symptoms at first and are unaware of the deterioration and complex changes happening within. It is essential to acknowledge that not having a period (premenopausal) is a sign of hormonal imbalances and underlying stressors. This must be addressed so that the serious long-term consequences of HA can be avoided.
Having struggled with hypothalamic amenorrhea for over three years, I can attest to the seriousness of this condition and the beauty of recovery. Remember, everybody is different, but I want to share with you what I did to support my body and regain my period. Even if you don’t have HA, these tips will help you embrace your cycle and get in tune with your body.
*I am not a doctor; I am just here to support you and share what works for me; consult a medical professional if you are not menstruating and believe you have HA
Healing From HA and Supporting Menstrual Health
Restore Energy Balance Through Nutrition
The body must find a balance of energy to regain a healthy cycle. This means listening to your body and fueling it with various high-quality, mineral-dense, and nutrient-rich foods. You deserve to eat! If you have HA, to regain your period, you will probably need to consume more.
Food is vital to life; we all need it to stay alive. The micro and macronutrients within food are what support our everyday function. Focus on seasonal and local foods — try out some new recipes. A balanced diet full of REAL foods without restriction helped me regain my cycle and feel my best. You can learn more about balanced and wholesome nutrition here.
Incorporating High-Quality Animal Products
For years, I restricted certain food groups, including animal products. I was vegetarian, then vegan for a while. However, excluding animal products from my diet caused me to be deficient in many essential nutrients.
I re-incorporated high-quality animal products into my meals, such as pasture-raised chicken and eggs, bone broth, grass-fed beef, wild salmon, raw dairy, and wild bison. All of these whole foods are excellent sources of protein and bioavailable nutrients. High-quality animal products have a place in a balanced diet, along with lots of fresh produce, legumes, and whole grains.
Remember, eating a variety of whole foods means getting various essential nutrients. Focus on REAL foods — know you deserve to eat what you want when you want it.
Stop Dieting and Restricting - Eat Regularly and Balanced
For the body to feel safe, it needs regular and balanced nutrition. Constantly yo-yo dieting and restricting increases stress, raises cortisol levels, contributes to HA, and deprives the body of essential nutrients. Regularly eat blood-sugar-balancing meals that contain all the necessary micro and macronutrients. Protein, fats, and carbs are all vital components of wholesome nutrition. You can learn more about balanced nutrition here.
Low-Impact Exercising
If you are without a cycle, you must reduce excess stress on the body. As you heal, focus on low-impact movements such as yoga and walking. Remember that exercising is a way to move your body, be healthy, and have fun, NOT to control your appearance.
This was a BIG step I had to take to regain my health and menstrual period. It was tough at first to take a step back — it felt like losing a part of myself and giving up an aspect of my control. However, I am so thankful that I did because, looking back, I was unhappy and unhealthy. Those things did not serve me during that time (with HA). To realize and accept that was to heal.
If you are a female athlete and want to learn more about hormone health and nutrition, you can find more information here.
Cycle Syncing
Cycle syncing is understanding, appreciating, and genuinely listening to your body. It embraces the natural fluctuations throughout the four phases of a woman’s menstrual cycle — supporting overall health and hormone balance. You can learn more about cycle syncing and natural hormone fluctuations here.
Surround Yourself with Support
Follow supportive, women-empowering, and embracing accounts. Surround yourself with people who make you feel accepted. Unfollow toxic accounts and let go of people who make you feel bad about yourself. You are enough, and you are beautiful.
Circadian Rhythm Health
Circadian clocks are our bodies’ evolutionary internal clocks. A circadian rhythm is a periodic pattern that takes about 24 hours, where the light and dark cycles synchronize biological functions with the surrounding environment. The circadian rhythms within our body harmonize physiology and behaviors towards the environment, acting as our body’s intrinsic clock.
For example, when in sync with the environment, this clock induces sleep and other related anabolic functions at night, such as growth and repair, hormone production and regulation, immune function, and wakefulness. During the day, a synchronized circadian rhythm is associated with catabolic functions such as cortisol production, digestion, and physical activity.
Circadian health is vital to normal hormone production and balance. You can learn more about the circadian rhythm and ways to foster circadian health here.
Regulate Your Nervous System
Stress is omnipresent in modern life, and because of this, our nervous systems are dysregulated — our bodies are in a constant state of “fight-or-flight.” Because of this, cortisol levels are elevated. Stress-induced amenorrhea is prevalent among young women. The body must return to a “rest-and-digest” state to support hormones and cycle health.
Here are some tips for regulating your nervous system:
Breathwork
Grounding
Sunlight
Laughing
Nature walks
Journaling
Unplug (take time off screens)
Red-light therapy
Legs up the wall yoga pose
Physical touch, hugging a pet or loved one
Cold therapy
Yoga and stretching
Therapy
Prioritize rest and sleep
Mindfulness
Meditation
Eat meals non-distracted
You can learn more about stress and nervous system health here.
Prioritize Rest and Sleep
You can read more about the importance of sleep here.
YOU are in Control
What you consume and do with the knowledge (or misinformation) you gain is entirely within your control. Today, the media uses a fear-based approach to spread information.
Information from social media manifests as noise and stress within the mind — this often overrides intuition and leads to a perceived external locus of control (feeling that you are not in control). However, YOU know your body best, and life is not a “one size fits all” situation. Choosing to reduce consumption of social media can significantly help reduce stress.
Remember that as long as you listen to your body and prioritize your health, you will be and feel okay; stressing about something is always worse than the actual thing. You have the power to prioritize nutrition and rest, educate yourself about your hormones and holistic health, and identify what does and does not serve you.
Practice Patience and Self-Love
Practice patience and self-love. It can take around three to six months to regain a regular cycle. Always be kind to your body and mind.
*If you are struggling with disordered eating or an eating disorder, know that you are not alone. You deserve love, patience, forgiveness, and to seek professional support.
Resources:
Sources:
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Pettersson F, Fries H, Nillius SJ. Epidemiology of secondary amenorrhea. I. Incidence and prevalence rates. Am J Obstet Gynecol. 1973 Sep 1;117(1):80-6. doi: 10.1016/0002-9378(73)90732-1. PMID: 4722382.
https://my.clevelandclinic.org/health/diseases/24431-hypothalamic-amenorrhea
https://my.clevelandclinic.org/health/body/22525-gonadotropin-releasing-hormone
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https://www.mayoclinic.org/diseases-conditions/amenorrhea/symptoms-causes/syc-20369299#:~:text=Mental%20stress%20can%20temporarily%20alter,may%20stop%20as%20a%20result.
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Tomiyama AJ, Mann T, Vinas D, Hunger JM, Dejager J, Taylor SE. Low calorie dieting increases cortisol. Psychosom Med. 2010 May;72(4):357-64. doi: 10.1097/PSY.0b013e3181d9523c. Epub 2010 Apr 5. PMID: 20368473; PMCID: PMC2895000.
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