Get Your Period Back: Hypothalamic Amenorrhea Recovery Signs, Risks, and Solutions

Today, I’m embracing my inner science nerd and talking about a women’s health topic that I really care about—losing your period—which is clinically termed functional hypothalamic amenorrhea (FHA). I'll speak to topics like hypothalamic amenorrhea recovery signs, risks, and solutions, and hope to break down some of the science for you.

Basically, hypothalamic amenorrhea is the loss of a period for three months or more. It comes with a host of consequences seriously affecting women’s mental, physical and emotional health. Many people looking for hypothalamic amenorrhea recovery information are often looking for reassurance that healing is possible and that their symptoms are valid. If that's you, I want you to know that hypothalamic amenorrhea is 100 percent reversible through lifestyle changes and that's the best part about it. Also, you're not alone— hypothalamic amenorrhea affects over 1.5 million women and people assigned female at birth in the U.S. So, if you or someone you know is experiencing hypothalamic amenorrhea, read on.

The Science Behind Hypothalamic Amenorrhea

There are three common hypothalamic amenorrhea causes: stress, under-eating and excessive exercise. While it’s possible that one of those three can lead to hypothalamic amenorrhea, more commonly all three of them are the culprits. And hypothalamic amenorrhea is a clear sign that the body does not have enough fat or weight to support a healthy reproductive cycle. Low energy (calorie) availability can disrupt hormones and eventually stop the menstrual cycle altogether.

So, here’s what happens in a normal reproductive cycle without hypothalamic amenorrhea:

• Hypothalamus (in the brain) releases gonadotropin-releasing hormone (GnRH).

• GnRH stimulates pituitary gland.

• Pituitary gland releases gonadotropins (reproductive hormones).

• Reproductive hormones (luteinizing hormone: LH – and follicle-stimulating hormone: FSH) signal ovaries to release hormones for a regular menstrual cycle.

But with hypothalamic amenorrhea, the above sequence (referred to as the hypothalamic-pituitary-ovarian axis) is interrupted and suppressed. Decreased gonadotropin secretion lowers estradiol (type of estrogen) production in the ovaries.

Some Hypothalamic Amenorrhea Signs & Risks

As you might expect, functional hypothalamic amenorrhea can cause infertility because ovulation is essential for natural conception. If it goes untreated for a long period of time, infertility risk goes up and muscle atrophy (muscle waste) occurs in the uterus. Miscarrying and preterm births are more likely with hypothalamic amenorrhea, too. What may be less obvious is how many other areas of your health it can also affect. In fact, it can lead to:

Decreased libido

The hormonal disruptions brought on by hypothalamic amenorrhea can cause loss of interest in sex and vaginal dryness, and many women notice a reduced sex drive long before their menstrual period disappears completely.

Bone diseases

A little less obvious is hypothalamic amenorrhea’s effects on women’s bones. But we need estrogen for bone metabolism, so the low levels of estrogen caused by hypothalamic amenorrhea put women at risk for osteopenia and osteoporosis.

Heart Issues

Low estrogen levels can interfere with blood vessel and endothelial (membrane in the heart and blood vessels) functioning — two major components of cardiovascular health.

Mental health problems

Since low estrogen is associated with things like the neurotransmitter serotonin (our happiness hormone), hypothalamic amenorrhea can cause moodiness. You’ll see below, too, that women with hypothalamic amenorrhea typically have high cortisol levels (our stress hormone), which means increased anxiety. And since hypothalamic amenorrhea is typically present in a chronic energy deficit, this means the sympathetic nervous system is always revved up and it’s difficult to relax, which ironically feeds into the hypothalamic amenorrhea even more. And hypothalamic amenorrhea is common in women with disordered eating and eating disorders, which are mental health conditions themselves.

Hormonal imbalances

Naturally, hypothalamic amenorrhea causes reproductive hormonal imbalance. Here are the hypothalamic amenorrhea symptoms that you will see on a hormone blood panel:

• Low FSH

• Low LH

• Low estradiol

• High cortisol (stress hormone)

• Low insulin

• Low leptin (fullness hormone)

• High ghrelin (hunger hormone)

• Low Triiodothyronine (T3- thyroid hormone)

How to Heal Hypothalamic Amenorrhea

I won’t go into intricate detail here but will include a few major components of hypothalamic amenorrhea treatment. I truly believe in lifestyle changes as the way to heal hypothalamic amenorrhea (and that birth control can serve as a dangerous mask). Why? Because the current research supports it, I healed my own years ago and I continue to watch my clients heal. In fact, according to a 2020 review, addressing the underlying factors (like inadequate food intake or overexercise) is the best approach to reversing hypothalamic amenorrhea. Here are some specific tips:

Take movement down a notch, or several.

This may mean taking a total break from any intentional physical activity until a period returns. It could also mean backing off exercise significantly but continuing to enjoy some type of movement routine.

Eat more food, especially carbs & fat.

There aren’t specific numbers of calories or fat grams to consume because each woman has her own threshold based on her physiology and physical activity. But overall intake needs to increase, and since carbs and fat are the two macronutrients typically restricted, emphasis on them is key. Carbs should make up at least half of our intake, hypothalamic amenorrhea or not. A hypothalamic amenorrhea recovery meal plan should focus on consistency, adequate carbohydrates, dietary fat, and enough total food to support healing. Increased hunger during recovery is extremely common and often a positive sign that the body is restoring balance.

Evaluate your relationship to food, body and exercise.

Healing from hypothalamic amenorrhea pretty much always means healing relationships to these things. The body is sending a clear signal that things are off balance and it’s time to get to the roots of the issue. Women recovering from eating disorder patterns often need support rebuilding trust with food and body cues. Rapid weight gain HA recovery fears are also very common, especially early in the process when the body is replenishing depleted stores.

Develop stress management tools.

Since stress is one of the root causes, making true self-care a priority is a really important part of the process. I often recommend therapy and mindfulness-based techniques like gentle/restorative yoga, meditation, journaling and breathing exercises. I also think allowing more fun and joy into daily life is really important in this process. And luckily, once the body is nourished enough and getting the rest it needs, cortisol levels will normalize and naturally lead to lower overall stress.

Hypothalamic Amenorrhea Recovery Signs

Hypothalamic amenorrhea recovery signs include return of regular menstrual patterns, improved basal body temperature, cervical mucus changes, more stable hormone levels. One of the other (and perhaps less obvious) hypothalamic amenorrhea recovery signs often includes a healthier relationship to food, body, and exercise. Some women also look for signs your period is coming in HA recovery, such as bloating, breast tenderness, or increased discharge.

Recovery is different for everyone, and hypothalamic amenorrhea recovery time can vary depending on stress levels, nutrition status, and how long the body has been under-fueled. Some women experience a first period after amenorrhea within a few months of making changes, while others need longer periods of consistent nourishment and rest. It’s also very common for the first period after amenorrhea light bleeding to occur before cycles become more predictable.

FAQs

Now, I'm sharing answers to some of the most common questions we get from clients, friends, and family members when it comes to healing hypothalamic amenorrhea

Is hypothalamic amenorrhea reversible?

Hypothalamic amenorrhea is absolutely reversible. It's possible to heal from the condition by addressing the underlying factor, which is usually under eating, overexercising, or too much stress—and often a combination of all three.

How long does it take to recover from hypothalamic amenorrhea?

The length of time it takes to recover from hypothalamic amenorrhea varies and depends on factors like severity of malnourishment and weight suppression, and length of time. If it's a side effect of an eating disorder, healing will happen once the person has progressed significantly in recovery. Hypothalamic amenorrhea recovery signs include things like return of menses, normalizing hormone lab values, and cervical mucus changes.

What does hypothalamic amenorrhea mean?

Hypothalamic amenorrhea is the loss of period for at least three consecutive months, because the hypothalamus—the control center of your brain—is not working properly.

Usually, the hypothalamus "talks to" your ovaries through what’s called the hypothalamic-pituitary-ovarian axis. Hypothalamic amenorrhea occurs after the axis is disrupted, leading to hormonal imbalance, loss of ovulation, and absent periods.

How do you fix hypothalamic amenorrhea?

Most often, hypothalamic amenorrhea is healed through lifestyle changes, including reducing or halting exercise, eating more food, and reducing or learning how to manage stress.

What are the symptoms of amenorrhea?

The main symptom of amenorrhea is the absence of menstruation. Other symptoms depends on the underlying factor. In hypothalamic amenorrhea, symptoms include infertility, decreased libido, mental health issues, and low energy levels.

A Note of Encouragement

I realize my hypothalamic amenorrhea recovery recommendations above are much easier said than done, which is why it is so important to practice self-compassion and patience, and to have a professional team (typically of a fertility doctor or gyno, therapist, dietitian and sometimes a psychiatrist) to help women make the changes in a way that feels supportive of their individual needs and circumstances.

For anyone interested in reading a more science-based article with research links, I wrote about hypothalamic amenorrhea in an article here. My recommendations are also supported by the clinical practice guideline published through the endocrine society clinical resources.

If you need help healing your relationship to food and body, please reach out to us via the contact page.

In true health,

Caroline