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Defining Hypothalamic Amenorrhea (HA) and Steps To Healing


Why are you not getting a period?

Stress!

Stress comes in many forms, and you may even be at a “normal” weight but still not get a period; thus, being “too skinny” is not the only reason we get HA.

 

Top sources of stress:

  1. Mental & emotional stress
  2. Over-exercising
  3. Too low carb
  4. Undereating
  5. Physiological stress

 

Other common reasons:

  1. Low dietary fat
  2. Rapid weight loss (or history of this)
  3. Eating disorder (or some variation)
  4. Low body fat
  5. Trauma

 

IMPORTANT: You do not have to have all of these to lose your period; in fact, it may only take ONE of these variables to cause a loss of menstruation. Our sensitivity levels all vary, and each body is unique. We’ll go into each variable in a bit more detail later…

 

How and why does stress cause amenorrhea?

The hypothalamus!

The hypothalamus is the hormone control center located in the brain that senses stress levels in the body and responds accordingly.

If the “holy” hypothalamus does not tell the pituitary to make sex hormones, a domino effect takes place, hormones don’t get made, and menstruation ultimately stops, resulting in infertility among other potential health complications that are a result in improper hormone levels.

 

Bottom line: Your hypothalamus has direct control over hormone production. You have direct control over the signaling of your hypothalamus.

 

Thankfully there is 100 percent reason to believe you CAN and WILL recover if you get to working on it, and you will regain your menstruation and fertility! Typically it take 3-8 months to see a period return, but this varies depending on how “all in” you go.

 

 

Factors in HA & Some Tips To Heal

 

STRESS MANAGEMENT 

HA is mental and emotional stress, and usually some level of anxiety/“OCD” tendencies that exacerbate stress. You may not even recognize all of it right now—it’s common to not even realize we’re stressed when we are so used to living stressed out—and part of the healing process is learning to recognize and manage stress better.

Stress-oriented personality traits

Research tells us that women who experience HA have similar personality traits. Below is a list of commonly shared traits. I want you to think about which traits apply to you, write it down and provide examples and provide examples from your life that explain each. Think about how you can override these things for better outcome. Even if you’re born with certain traits and tendencies you’re not doomed to be that way – you have a choice! Writing it all down, is free therapy!

  1. Neuroticism
  2. Insecurities
  3. Anxiety conversion trait
  4. Hypochondria
  5. Depression
  6. Emotional lability – i.e. a tendency to laugh or cry unexpectedly
  7. Difficulty adapting to distress, change or tough situations
  8. Also: Women place more emotional emphasis on relationships, and this makes us more prone to mood disturbances and stress

 

FOOD-RELATED ISSUES

Many gals with HA feel a lot of stress toward food. Mental stress over food (“what to eat,” what not to eat, counting calories, macros, fear over unhealthy food, etc.) often do more harm than we realize. Some ideas to help:

  1. Meal time = chill time – Make meals a priority, don’t rush food or eat main meals while on the go. Set the scene and get in the right mindset before meals so that your eating time can be stress-free, slow and mindful. Be present and ZERO distractions when you eat (no computer, no phone and try to avoid eating on the go except for snacks if needed). Go overboard in setting up a relaxed environment and fake it till you make it at first. This will also help digestion!
  2. Don’t label foods good or bad; don’t restrict – There are no “bad” or “good” foods. You can think of foods as “efficient” or “inefficient” instead. No matter what, it’s just food, and as long as you eat in moderation and abide by 80/20 in terms of mostly making quality choices, you’ll be fine! Generally eat foods that make you feel good and energized, but don’t feel limited and that you can “only” eat x,y,z and not a,b,c. No avoidance, no restrictions.
  3. Make food fun! Get in the kitchen and bake or cook something amazing, have some wine while you’re at it and just enjoy it. It can be a healthy recipe but don’t force anything that fits in a diet. Try something you’ve never made before. Be adventurous.
  4. End orthorexia – We can and should all strive to be healthy but not to a detriment where it causes more stress. So just be aware.
  5. Re-read “Food Stress and Its Affect on Metabolism.”

Meanwhile, there’s often a component of restriction in the diet whether it’s lacking enough calories, cutting out certain macros, or even

  1. It’s all about energy availability  – Lacking energy balance (too many calories out, not enough coming in) is often a main factor that causes HA. Research shows that once energy availability (EA) is recognized, then women tend to regain menstruation. It’s the king of variables! You need to let your body know that there are enough calories coming in and you’re not in starvation mode. Thus, always make sure you’re eating enough to support your daily energy expenditure and don’t worry for a second about fat-adaptation or macros right now. When in doubt, eat! Sometimes we have to teach ourselves to eat more and learn that what we think is “feeling full” is still not enough; in fact, reserach shows that exercise can blunt feelings of hunger leading us to under-eat–avoid this mistake.
  2. Carbs – Ideally take in 150-300 grams of carbs a day, and ZERO focus on low carb for the moment. Carbs are utterly essential to regaining your period. End of story. I hesitate to even mention actual numbers of grams, but it’s there for you to meet minimums not accidentally stay low.
  3. Fat – Also eat dietary fat in abundance, don’t measure your fat just eat it.

 

A NEED TO RELAX

  1. Schedule it – Make more time to just chill out and be lazy. Yup! I said be lazy more often! Schedule it in if you must and don’t miss your appointment! More thoughts/ideas instead of gelling on the couch:
  2. Meditation – minimum 10 minutes on most days (don’t feel guilty if you miss it), or a meditation walk – where you go into a mode of being fully present no distractions. Set the scene with music, a special consistent spot, etc. If that still doesn’t work, then just schedule at least 10 minutes of YOU time with no one else who can interrupt your special time and do something chill.
  3. Take a nap! – Sleep a lot! Don’t feel guilty about it!
  4. Relaxing yoga – While something like bikram is certainly awesome, it will be a bit more intense, so don’t go overboard and be honest with the yoga practice you choose.
  5. Sex – you may not have a strong sex drive but you can still work at it, and the more sex you have the better you’ll feel – GUARANTEED!!!
  6. More self-love – Don’t be hypercritical. Be kind to your body and your self, mentally speaking, YOU come first! Say nice things, treat yourself nicely and try to eliminate self-criticisms; simply feed yourself a positive thought if negatively creeps in. The more you love yourself the more relaxed you’ll inevitably be!
  7. Be Gentle (physically speaking) – You’re not a machine so don’t treat yourself as such. I can remember thinking back in my HA days, “I can do whatever I want because I’m strong enough; I can handle more than the average person because I said so; I can train harder, have a better diet, be skinny, be skinner and more ripped than the average girl, drink and party, work my ass off, and have it all.” Ok, not so much! We are human and have limits! Get to know yours, and don’t think that doing less or slowing down a bit means you’ve gotten soft – it actually means you’ve finally wised up! Respect your body for what it CAN do and also for what its LIMITS are. You don’t always have to be pushing so damn hard 24/7.

 

EXERCISE

  1. Avoid over-exercising – Next to food issues, this is often the biggest contributor to HA. And what we consider to be normal amount of exercise may indeed be too much. There’s a good chance you need to scale back and change your exercise habits to regain menstruation… and don’t worry, you can likely eventually bring back more exercise once you’ve healed.
    1. Limit volume – I’d avoid anything longer than 90 minutes for the time being. Also keep workouts including focused walking/hiking to <10hr/week.
  2. Be active but don’t force it – You don’t have to quit everything and become sedentary; that’s no good either. But forcing exercise when you’re body clearly doesn’t want it has to stop. We may be used to heading out the door to pound miles no matter how we feel, but now stop and think about it – maybe a nice walk or heading back to the couch to read might be the better answer. Keep in mind – when you’re in a good balance with exercise you start craving a workout rather than feeling tired and heavy but going out to workout regardless. So right now, just keep exercise mellow and less is more!
  3. Add up all movement – I used to think walking was not exercise, and yoga didn’t count – I was wrong! If your definition of “exercise” means that you have to break a sweat or get your HR up, that’s wrong! Yes, walking and very low-intensity yoga are still technically forms of exercise that burn calories, so add that into your activity log. I say this because we sometimes don’t realize how much we’re actually doing with our bodies day in and day out! Movement counts and burns calories!
  4. Food & exercise – Absolutely ZERO fasted training/workouts and always incorporate food into your workout plans, either a meal or snack before or after, or both – eat before & after. Anything longer than an hour even more important to consider fueling.