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Today, I’m embracing my inner science nerd and talking about a women’s health condition that I really care about: Functional Hypothalamic Amenorrhea (FHA).
Basically, FHA 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.
BUT it is 100 percent reversible through lifestyle changes and that is the best part about it. So, if you or someone you know is experiencing FHA, read on. If not, my next blog will be another science-y one that affects all humans — nutrition and mental health, and how the two are both intertwined — come back for that one in May!
The Science
Three factors are at play in FHA: stress, under-eating and overexercise. While it’s possible that one of those three can lead to FHA, more commonly all three of them are the culprits. And FHA is a clear sign that the body does not have enough fat or weight to support a healthy reproductive cycle.
So, here’s what happens in a normal reproductive cycle without FHA:
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 normal reproductive cycle.
But with FHA, 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.
The Risks
Decreased fertility. This is perhaps the more obvious consequence of FHA. 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 FHA, too.
Decreased libido. The hormonal disruptions brought on by FHA can cause loss of interest in sex and vaginal dryness.
Bone diseases. A little less obvious is FHA’s effects on women’s bones. But we need estrogen for bone metabolism, so the low levels of estrogen caused by FHA 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), FHA can cause moodiness. You’ll see below, too, that women with FHA typically have high cortisol levels (our stress hormone), which means increased anxiety. And since FHA is typically present in a chronic energy (calorie) deficit, this means the sympathetic (fight-or-fight) nervous system is always revved up and it’s difficult to relax, which ironically feeds into the FHA even more (remember, one of the other root causes is stress!). And FHA is common in women with disordered eating and eating disorders, which are mental health conditions themselves.
How to Heal
I won’t go into intricate detail here but will include a few major components of reversing FHA but I truly believe in lifestyle changes as the way to heal FHA (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.
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, FHA or not.
Evaluate your relationship to food, body and exercise. Healing from FHA 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.
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 decrease and naturally lead to lower overall stress.
I realize the 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 FHA in an article here.
And if you’re interested, here are the clinical indicators of FHA (what 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 grehlin (hunger hormone)
Low Triiodothyronine (T3- thyroid hormone)
And if you are struggling with your relationship to food, your body or exercise, I am taking on new virtual clients and would love to work with you. Please send me an e-mail at thewholeyogird@gmail.com and we can set up a free discovery call to see if we are a good fit!
In true health,
Caroline