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Hypothalamic Amenorrhea

If fatigue, hunger, hair loss, feeling cold, non-existent libido, sleeping troubles, missing period or irregularity sound familiar, you have come to the right place. 


To listen to my podcast episode on hypothalamic amenorrhea, listen here, or continue reading below.


When I was younger, I struggled with disordered eating and, consequently, hypothalamic amenorrhea. This topic really hits home for me and I know that I am not alone.


Food and exercise are areas of trauma for most of us women. I see, more often than not, both in my private wellness practice and in research, that women’s menstrual and overall health are declining due to undereating, overexercising, and yoyo dieting. When done chronically, disordered eating can lead to hypothalamic amenorrhea. It is estimated that HA affects approximately 1.62 million women between the ages of 18 and 44 in the United States and 17.4 million women worldwide.


How undereating shuts off ovulation:

  • Our bodies need fuel in order to function properly. 
  • Too little calories or too little of any macronutrient (i.e. carbs and why I do not agree with the keto, carnivore, or low carb diets) can downregulate sex hormone production by upregulating cortisol and our stress hormones. To go even deeper, restrictive eating and/or coupled with being underweight can switch off the signaling of the hypothalamus to the ovaries. Your body is not broken, it is actually very smart for doing this.
  • Too little fuel lets our brain know that we are NOT safe enough to reproduce. It also tells our thyroid that we are in starvation mode and it needs to slow down in order to reserve its energy, which cues more period problems and weight fluctuations, cold hands/feet due to poor circulation, hair loss, etc. 
  • Too little fuel tells our adrenals to pump out cortisol, our stress hormone which can cause anxiety, irritability, hangry/cravings, sleep problems, weight gain around the midsection)
    • Higher cortisol levels also suppress the thyroid
  • This is also called relative energy deficiency which is the ratio between energy intake, body mass, and energy expenditure AKA how much you eat, how much you weigh, and how much you move your body. Regardless of body size, the primary driver for HA is an energy deficit from undereating and overexercising.

Why doesn’t this happen to men even though their hypothalamus dials up or down testosterone? Well, because they will never have to worry about carrying on life and the 75,000 additional calories it takes to grow a baby. Our cycles, baby or not, are HIGHLY energetic processes.


The role of the Hypothalamus:

  • This area of the brain plays a vital role in maintaining the balance of the body systems. It receives input from how we eat, move, see, think, etc., in the form of hormones and other chemical messengers. It responds by telling organs to secrete certain hormones. 
  • A chronic energy deficit tells the body to suppress less vital body functions, such as reproduction, therefore causing hypothalamic amenorrhea. 
  • Contributing factors: energy imbalance, undereating, ED, stress, weight loss, genetics (we will get into in a moment), over exercise. 
  • Food restriction, especially carbs and fats. 

Everyone is DIFFERENT!

  • Some of you listening may have a friend, or perhaps yourself, who did not lose their period even while juice cleansing, keto, etc.. This is because we all are more or less susceptible to HA depending on our ancestry. This is known as the ovarian set point as explained by evolutionary biologist Grazyna Jasienska in her book Fragile Wisdom. This means that we all have different requirements for food energy to be able to ovulate. Some of us need more, others not as much. 

What to do:

  • Unfollow toxic accounts / people in your life
  • Follow woman-empowering and body normative accounts
  • Stop dieting and eat regularly and eat a blood-sugar-balancing meal that contains all of the needed micro and macro nutrients. 
  • EAT MORE. 
    • Eat mineral rich and nutrient dense foods
  • Don’t over exercise. Walks and yoga will be your best friends as you get your beautiful flow back!
  • Try therapy
  • Mindfulness
  • Stress reduction
  • You hold the power. You can choose to play and be silly. To fuel your body. To prioritize sleep. To seek out professional help. To say no to what does not serve you. 
  • Add in ovulation-supporting herbs, like the ones found in Soothe
  • Expect for 3-6 months of recovery to get your flow back. Be patient and loving with yourself.

If you have an eating disorder:

Vocabulary:

  • Primary amenorrhea is the failure to reach menarche by age 15 in the presence of normal sexual development. 
  • Secondary amenorrhea is the loss of a regular period for 3 months or an irregular cycle for sixth months due to an underlying condition, one of which could be hypothalamic amenorrhea. 

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