Hypothalamic Amenorrhea//Where’s your flow at?

A missing period is not something to be overlooked or brushed aside, rather seen as a serious warning flag from your body that something is not right. From puberty to menopause your body is designed to reproduce. Whether you want kids or not, this is the state your body will function most optimally at. Going long stretches of time without a period will disrupt the intricate balance of hormones leading to negative symptoms and disease in the short and long term. If your flow has gone MIA the time is NOW to work on getting it back. Please do not wait until you want to get pregnant to focus on recovery, your period is something you should prioritize getting back as it’s a sign of health! 

In this blog, we will dive into why you don’t have a period, the consequences of not having a period, and how to get your flow back. 

WHY YOU DON’T HAVE A PERIOD

Hypothalamic Amenorrhea is a medical condition in which women of childbearing years miss 3 or more cycles. There are two types of amenorrhea, primary and secondary. For this article, I will be addressing secondary hypothalamic amenorrhea which is commonly seen amongst those who are suffering from an eating disorder, are a collegiate/amateur athlete, or a chronic dieter. What do these populations have in common? Two words for you— Energy Debt. 

When the body dips into an energy debt, expending more than it receives, it is sent into a hypometabolic state and the HPA axis gets disturbed. The HPA axis consists of three glands in the body; the hypothalamus, pituitary, and adrenal glands. The HPA axis is “ an eloquent and every-dynamic intertwining of the central nervous system and the endocrine system” –integrative pro. It plays a key role in maintaining homeostasis and how the body handles stress. When the HPA axis perceives stress it will alter the endocrine system leading to things like amenorrhea.

 Let’s take this a little further and look into exactly how this happens. 

The hypothalamus is a gland located in your brain that controls reproduction. It does this by sending out gonadotropin-releasing hormones which in turn signals to the pituitary gland to start releasing follicle-stimulating and luteinizing hormone for you to grow and release an egg. A couple of days (about 14) after this process your period comes as you shed the lining of the uterus because pregnancy was not achieved. 

The hypothalamus is constantly receiving autonomic regulatory input from the limbic system. In layman’s terms, the hypothalamus will pick up on any stress in the body and address its commands to various other glands according to the data it collects. When the hypothalamus perceives an energy deficit, it ceases the release of certain hormones that are in charge of growing and releasing an egg. It does this for your safety as becoming pregnant would put a big strain on your body. 

So what causes you to go into an energy debt?

Energy debt can be achieved by any or all of these things;

-Overexercise—Exercise is great for the body but just because it’s great doesn’t mean MORE is better. In fact, over-exercising can be very damaging and taxing. As you exercise cortisol levels rise which signals to your hypothalamus that you are in a stress state. In a healthy body this stress is fine, can even be beneficial, but in a taxed body this further depletes your body and sends cortisol to skyrocketing levels. 

Exercising utilizes a lot of energy thereby overdoing it will send you into an energy debt, especially when food intake does not match up with exercise expenditure. 

-Under-eating—Your body doesn’t run off of thin air (imagine that). If you do not get enough calories each day your body will slow down your metabolic rate and start pulling from your body’s reserves, further depleting your body and creating a larger debt. The HPA axis perceives this lack of food to be a sign that you are in an unsafe place where resources are scarce. No time to make a baby while you’re in the middle of a famine! I see many people online advocating for a 1200 calories diet which is simply way too little for a woman of childbearing years ESPECIALLY if she is active on top of that. 

-Restrictive diets—Cutting out all carbs, avoiding dairy, eliminating meat, choosing low-fat products, — all are common examples of a restrictive diet. There is a reason why each macronutrient exists– your body needs it. Manipulating your macros to achieve an aesthetic goal can lead to lots of hormonal imbalances as your body does not have all the resources it needs to stay in an energy balance. 

-Stress— physiological stress can be a factor in developing HA. Examples of this would be the loss of a loved one, finishing your degree, relationship issues, divorce, financial struggles, etc. Stress elevates cortisol which lowers your sex hormones. 

-Weight loss—weight loss, especially when done quickly, is a stress to the body and can signal an alarm to the HPA axis to shut off hormonal productions EVEN if that weight loss does not get you to an unhealthy low weight. 

 Low weight and low body fat percentage— As women we need a higher body fat percentage than men to maintain proper hormonal balance. I am sorry don’t get mad at me about it, that’s just how it is. While our society has deemed fat to be bad, biology says something else. Fat is necessary for keeping your warm (insulation), protecting your organs, storing nutrition, and building key cell messengers that are important for cell communication.

NEGATIVE CONSEQUENCES OF AMENORRHEA

While skipping that monthly bleed may seem nice, there are some big downsides to not menstruating every month. 

-osteoporosis

-iron overload

-cardiovascular risk

-low sex drive, vaginal dryness, vaginal/vulvar/clitoral atrophy

-Hair loss/thinning

-Low progesterone leading to estrogen dominance 

-Infertility

-Digestive issues— constipation + bloating are very common. 

-Feeling disconnected from your internal rhythms, emotions, and moods. 

-neurodegenerative disease (Alzheimer’s, Parkinson’s, MS)

HOW TO GET YOUR PERIOD BACK!

It irritates me that the first solution that many people, including doctors and gynecologists, think of is Birth control. Sounds like the best solution right? Take this pill and you’ll be all better again! Not so quick there. 

Unfortunately, birth control is not the solution or even a solution. Your body has not developed amenorrhea due to a lack of birth control rather for the reasons we mentioned in the above section titled, “Why you don’t have a period”. Read back over that section if you are still wondering why you don’t have a period. To learn more about why I would personally not take birth control to fix amenorrhea you can read this post here.

-Eat enough to not only sustain your body’s daily needs but to repair them too. 

-Reduce/eliminate exercise

-Gain weight. 

-Reduce Stress— This isn’t about magically creating a life where stress doesn’t exist rather creating consistent habits and practices in your life that will help you offload this stress and manage it better. Look into things like setting up better work systems, managing your time better, prioritizing things that matter to you and letting go of those things that are depleting, reach out for support, seek out moments of solitude (aka shut your phone off), allocate work to others, etc. 

WRAPPING IT UP

You can get your period back naturally! It takes time, dedication, and commitment to the process but it’s 100% possible *unless a medical professional has diagnosed you with an abnormality or other malady like a pituitary tumor. 

The process is hard, especially when you have an unhealthy relationship with food and a negative body image, which is where a coach can be extremely helpful. I have helped women from around the world restore their flow by helping them nutritionally rehabilitate their bodies, release food fears, overcome exercise addiction, and love food again!

 I love helping others get their period back as I too suffered from amenorrhea for 11 years and understand how challenging AND rewarding this process is. If there’s just one thing I want you to take away from this article is that you are not broken and your body can heal! 

Reach out for 1:1 recovery coaching or learn more about the Get Your Flow On course!

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