Did you recently go off birth control only to find that your period just never came back? Or maybe you’ve realized it’s been a while since your last period and you’re most definitely not pregnant.

What gives?

Losing your period, as nice as that may seem for a bit, is not normal. Rather, it’s a sign from your body that something isn’t right. A missing period suggests that the body isn’t able to support a healthy reproductive system, which has implications far beyond making babies.

Hypothalamic amenorrhea often occurs in folks who, on the outside, seem like they’d be the “picture of health.” Exercising often, eating “clean”, losing weight or successfully following a diet may be celebrated by society, but not necessarily your body.

If you suspect you may have hypothalamic amenorrhea, you’re probably wondering what you need to do to recover. Or you might be feeling stressed out by the prospect of period recovery and are wondering if there are any shortcuts.

I’m here to help you on the path to getting your period back – keep reading for my top tips.

What is hypothalamic amenorrhea?

Reproductive hormone functioning starts in the brain. In the hypothalamus to be specific. 

The hypothalamus is the hormonal control center in the brain. It perceives constant information about the environment and the state of your body’s wellbeing to coordinate various functions in the body. 

When the hypothalamus determines that the body is unable to cope with the burden of stress it’s under, it turns down the production of reproductive hormones involved in the menstrual cycle. 

Because making babies isn’t a smart use of the body’s resources during times of distress (like famine or illness), the brain prioritizes more “vital” systems when it senses this kind of threat. 

Sources of stress that can lead to hypothalamic amenorrhea

  • Inadequate energy intake (not eating enough energy/calories to support the body’s physical functioning)
  • Excessive energy expenditure (exercising so much that the body can’t keep up)
  • Weight loss or weight suppression (though HA can occur at any BMI)
  • Chronic sleep disruptions (which usually happen secondary to malnutrition)

Not getting a monthly cycle is not normal. It’s ultimately a big red flag that your body is dealing with a huge amount of stress, which is linked to a host of other health issues. I’ll go over some below.

Why is getting a period important?

Having a regular menstrual cycle is obviously important if you want to become pregnant in the near future. If the body is suppressing ovulation and not prioritizing the health of the endometrial lining in your uterus, the chances of conceiving naturally are very low. 

Reproductive hormones are also closely connected to the integrity of other body systems. If the body isn’t prioritizing reproductive hormones, other body systems suffer, too.

Not getting a period greatly increases the risk for low bone density and osteoporosis, as the hormone estrogen regulates bone metabolism. Bone density is generally not something that can be easily reversed, especially after the age of 30 . 

Hypothalamic amenorrhea is also associated with an increased risk for cardiovascular disease. While the connection is not yet fully understood, individuals with hypothalamic amenorrhea tend to have more heart disease risk factors than those who have normally functioning menstrual cycles [*].

Mood disorders like anxiety and depression are more severe in those with hypothalamic amenorrhea [*]. While correcting nutritional deficiencies doesn’t totally cure mental health issues, it makes dealing with them feel a lot more manageable.

Hypothalamic Amenorrhea often occurs due to under-eating (in the context of an eating disorder or not). Under-eating leads to malnutrition and a deficiency in important nutrients body-wide. Malnutrition affects every system in the body. Often symptoms of malnutrition show up as digestive discomfort (i.e. pain, bloating, constipation), poor immune function (getting sick all the time or not rebounding well after an illness), hair loss, brittle nails, dull skin, tooth decay, muscle loss or weakness, difficulty sleeping, and low libido. 

How to get your period back on track

To restore your body’s ability to maintain a menstrual cycle naturally, it’s important to address the root cause(s) of your missing period. 

First, make sure that hypothalamic amenorrhea is the correct diagnosis. Typically there are a few diagnostic tests that will rule out other conditions such as hypothyroidism or polycystic ovarian syndrome (PCOS) that can cause irregular or missing periods. There is no one diagnostic test that indicates hypothalamic amenorrhea, so it’s largely a diagnosis of exclusion (as well as using other data points to help paint a diagnostic picture). 

Eat Plentifully & Consistently

One of the primary ways the body interprets whether it is safe or not is by keeping tabs on energy availability over the course of days / weeks / months / years. Not eating enough to support your body’s basic needs is a huge threat to survival. Especially if you’re also exercising a lot at the same time. (funny how “eat less and move more” is often the advice dished out by – let’s face it, under-educated – health care providers).   

To help the body achieve a sense of safety and have enough resources to devote to reproductive hormone function, you need consistent and plentiful nourishment which includes ALL macronutrients (carbohydrates, fat and protein). Now is the time to work on letting go of food fears, food rules and any restrictions you’ve held around food. This is where a dietitian like myself can help.

Slow Down

Whether you’re coming from a place where exercise is your lifestyle, identity, or primary outlet, moving less can be super hard to do. BUT it’s critically important when it comes to establishing a sense of safety in your body. 

Exercise, even in the context of eating enough, places a high burden of stress on the body. In normal circumstances, the body’s ability to recover from this stress is what leads to improvements in things like strength, endurance, cardiovascular health and more. But when the body doesn’t have resources to support exercise or recovery from exercise, that stress builds and builds and can contribute to a host of issues – from injuries to poor immune system function to digestive dysfunction and worsening mental health. 

In order for the body to A) have access to enough resources to support hormone production and B) feel safe enough to prioritize reproductive organs, reducing the intensity and frequency of exercise is often necessary.

Of course, this is not always as easy as just deciding to take more rest days. There is often a lot that we attach to exercise that makes stepping away incredibly difficult. Often the body needs a fair amount of time away from intense exercise. This means you’ll probably need to spend some time exploring your relationship with movement in general. I can help here, too.

Prioritize Sleep

Take time to prioritize nighttime routines that help you feel cozy and encourage sleep. Seep is foundational for the brain and body, particularly when it comes to hormone regulation. Not getting enough sleep adds to the total amount of stress your body experiences. This means that even if you’re eating more and moving less your brain may still not feel safe. 

Sleep is often disrupted as a side effect of malnutrition or chronic hunger. So you might find that once you start eating more and restoring nutritional deficiencies, restful sleep becomes easier to achieve. 

Sleeping during biologically appropriate hours (when it’s dark outside) helps the body align with its circadian clock. This supports the cascade of hormone production needed to properly regulate metabolism, appetite, and reproduction.

Address Stress

Other sources of stress can impact your cycle, too. Chronically feeling “on edge” or like you’re one stubbed toe away from a complete breakdown is not something to ignore.

Our culture likes to glorify being constantly busy, but that’s simply not healthy. Reflect on what’s causing the most stress in your life. Explore ways to set boundaries that put your mental and physical health as the priority. Try not to let this become another “to do”. Adding yoga classes or meditation on top of an already-packed agenda is ultimately not a fix.

Get Professional Support

I would never recommend going this alone. It’s just so much mental and emotional work and you deserve to be wholeheartedly supported. Recovering from Hypothalamic Amenorrhea is far from easy. An experienced registered dietitian and mental health therapist are key. So is a medical provider who supports all of your questions and concerns. Other providers, like athletic coaches, physical therapists and psychiatrists may be able to help in specific situations. 

Do you have to gain weight to get your period back?

Everyone’s body and experience is going to be unique. But the most common experience is that YES, you probably have to gain some weight to get your period back. This is especially true if you lost your period due to overexercising and under-eating. 

Body weight is one of the indicators the hypothalamus uses to determine whether the body is safe (or not). Each of us has a genetic blueprint of where our body functions the best. This is known as our “set point” weight range. This is not based on a chart of BMI or “ideal” weights. But rather on our unique physiology AND the lived experience of being alive in your body.

Under-eating and/or overexercising can cause the body to be “weight suppressed”, or exist at a size that is below the threshold for safety. While weight isn’t everything (of course!), it’s often not possible to restore nutrition and allow the body to rest adequately while also trying to avoid any weight gain. This is counterproductive. If your body effortlessly restores weight while you increase your energy intake and reduce your energy expenditure, it’s because your body needs that body weight to feel safe.  

Will you just keep gaining and gaining weight forever and ever? No. Even though it feels like this will be true, physiologically that isn’t likely and generally isn’t how bodies work. Depending on your unique biology and lived experience, your body will probably want to gain enough to return to its set point. Many individuals may find that their body even needs to “overshoot” this set point range at the beginning before settling back into their body’s safe set point over time.

In our size-obsessed, weight focused world, the prospect of gaining weight can feel incredibly scary. The process of gaining weight can bring to light so many internalized fears and biases you may not have even known that you hold. Give yourself plenty of space and support to work through this. Coming to terms with gaining weight doesn’t have to happen overnight.

What to do if you’re struggling

If you’re still with me and you’re feeling overwhelmed with the prospect of recovering your period, I get it. I was you, too! I wouldn’t have gotten to the place I am today without the support of dietitians, therapists, and medical providers along the way. It’s OKAY (and encouraged!!) to ask for help. 

The first step is reaching out. Shoot me a quick message to let me know you’re looking for support with hypothalamic amenorrhea. I’m more than happy to help you in your journey.