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Hypothalamic Amenorrhea: What you need to know to help get your period back

We talk a lot about hormones with the work that we do, and if you’ve read many of our blogs or worked with us before, you know that hormones control just about every function in the body. We interact with many women who aren’t having regular periods, which is a major sign of hormonal imbalance and can be especially frustrating for those who are trying to conceive or hope to become pregnant in the future. 

There are many reasons why a missed period may occur, but one of the most commonly overlooked causes is a condition called hypothalamic amenorrhea. This can be a complicated term, so we’re here to help break it down to describe what it is, what causes it, and what you can do about it to help rebalance your hormones and get your period back for good. 

What is hypothalamic amenorrhea?

Hypothalamic amenorrhea (which we’ll abbreviate as HA from here on) is a condition in which a women who has previously had menstrual cycles loses her period for at least a few months in a row due to a problem with the hypothalamus, a portion of the brain that helps regulate hormone production via the pituitary gland. Basically, the body stops making enough estrogen or progesterone, which causes ovulation to stop and missed periods to occur. 

Missed periods can go on for months or even years in many women. To some, this may not sound like not such a bad thing, but it can have significant negative impacts on the body. Since estrogen plays many roles in the body, research shows that inadequate production can lead to problems with the cardiac and skeletal systems as well as psychological health, and of course reproduction. So regardless of your goals for a future pregnancy, HA is definitely something you don’t want to ignore. 

Causes of hypothalamic amenorrhea

The causes of HA can be seemingly subtle and are usually unintentional. In addition, what causes one woman to develop HA may not be the case in another woman. So, it’s very much individualized and requires specific attention. 

The most common causes of HA include:

  1. Over exercise. Excessive exercise can disrupt activity between the hypothalamic-pituitary glands which control ovarian function (and contributes to ovulation). There’s no set amount or type of exercise that gets defined as excessive since it can be different for everyone, but it may include things like frequent and prolonged distance running or other cardio activities, intense interval training, and the like. 
  2. Undereating. We spoke a lot about the ways that undereating can negatively impact your health in this post, and disrupting reproductive function is definitely one of them. The body needs a certain amount and specific balance of nutrients in order to operate properly. When there is a lack of proper fuel, sex hormone production will be halted and things like having a period and being able to conceive may not be possible. Keep in mind that undereating can occur in women of any weight, so the size of your body is no indication whether or not you’re eating enough. And like exercise, there’s no specific calorie limit that defines undereating, so even if you feel like you’re eating enough, you may not be.
  3. Stress and/or “adrenal fatigue”. Being overstressed can wreak havoc on the endocrine system, including the hormones that regulate reproduction and the menstrual cycle. This stress can be physical, mental, or emotional. Women with HA have also been shown to have higher cortisol levels (a major stress hormone), so stress goes both ways with this condition.
  4. Significant weight loss. The body requires a specific amount of body fat in order for menstruation to occur. Since weight loss often causes loss of body fat, it has been shown to be another major contributing factor to HA. This applies to anyone who has lost weight, even if the endpoint is still at a higher weight than what is considered “normal”. 

What you can do to help get your period back

The first step is always to find the root causes(s) of what may be contributing to HA in the first place. This may be easier to identify for some compared to others. Take a look at your lifestyle and notice if any of the things mentioned above apply to you. We also strongly recommend working with a trained healthcare practitioner for a more detailed evaluation. 

Here are some steps you can take to help resume normal cycle function:

  • Focus on gentle exercise. Don’t get us wrong, exercise is good for the body. So while over and intense exercise can contribute to HA, it doesn’t mean that you have to cut out physical activity altogether. The key is to just be gentle with your body, and focus more on activities like walking, yoga, and light cardio, and to do so only when your body is in the right state for it (not when you’re overly stressed or didn’t sleep well the night before). Pay attention to your body’s cues to guide what activities would feel best for you, and don’t be afraid to skip an activity if you’re just not feeling it. 
  • Prioritize stress management. We talk about stress all the time because it really is that important. Some stress is unavoidable, but more of it is manageable than you may realize. Things like setting boundaries, relaxation, sleep, and self-care are just some of the things that should be emphasized while recovering from HA. You can read more about adrenal fatigue and tips for overcoming stress and burnout here. 
  • Address your eating habits. It’s okay to be striving to eat a healthier diet, but ibe careful to not turn this desire into an obsession that may cause overly restrictive eating. At the very least, women should be eating 3 balanced meals each day with snacks as needed, and these meals should be complete with high quality protein, fat, and carbohydrates. Specific nutrient supplementation may also be warranted. Women with disordered eating may have an especially difficult time recovering from HA, so if you have any concern about your relationship with food, definitely seek help. 
  • Aim for a more gradual approach to weight management. You can still pursue a different weight for your health, but it should be done so gradually and only while also engaging in the gentle exercise and balanced diet just discussed. Losing weight rapidly is not only not sustainable, it can also be dangerous and definitely makes the likelihood of HA greater. Keep in mind that gradual weight gain may also be needed in order to regain normal function of the reproductive hormones. We recommend working with a professional to help determine what your weight priorities should be.  

 In addition to the above, receiving medical workup from your doctor is a good idea to rule out any other potential causes, such as an issue with your pituitary gland or other lab abnormalities.

Bottom Line

Women are meant to have periods, and the loss of normal menstrual function is a red flag not only for reproductive purposes, but also for general health. HA is more common than most people realize, and it often happens without intention or even realizing it at first. Thankfully, there are practical steps you can take to adjust your lifestyle and regain normal hormonal balance. Recovery IS possible! Feel free to reach out to us with any questions or to start working together on your health journey. 


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