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Overcoming hypothalamic amenorrhea

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Far back in the very beginning weeks of this blog, I wrote a long series of articles on the sources of infertility.    In terms of the kinds of infertility caused by diet and lifestyle, there are two primary categories: PCOS and Hypothalamic Amenorrhea.  Long time readers of this blog know that I believe the relationship between these two disorders is much more complicated than regular doctors and medicine would have us believe.  Nonetheless, while I was writing about PCOS and HA (read more about HA here and here and here), I promised to write a post on how to overcome HA.

I never did.

The reason I didn’t write it is because the answer is both way too complex and way too simple.  I couldn’t come up with anything coherent to say.

Hypothalamic Amenhorrhea is the fancy way of saying “stress-induced loss of menstruation.”  The hypothalamus is the part of the brain that determines if you are in a safe enough environment to bear children.  If your body receives signals that you are not “safe” enough, then your hormone production will decrease and you will stop menstruating.  You may also suffer symptoms of low libido, depression, anxiety, insomnia, acne, and fatigue.

“Safe” means both physiologically and psychologically.  Mental stress can hurt your fertility just as much as physical stress.  Unfortunately, these two stressors commonly occur in women today, and commonly in paleo dieters.  Mental stress comes from pressure and ambition and work and life as well as body image issues, low-self-esteem, and disordered eating.  Physical stress comes from low body fat levels, rapid fat loss, excessive fat loss, fasting, over-exercising, under-sleeping, and under-eating.   It’s no wonder that so many women struggle with this.

 

 

Estrogen, progesterone, LH and FSH — all female hormones — decrease with hypothalamic stress.  LH and FSH come directly from the pituitary and fall off the wagon, and then estrogen and progesterone, which take their cues largely from LH and FSH, fall off of it, too.

Can it be overcome?

Sure.

Is it easy?

Not always.

——————–

The thing about HA is that its severity and “cure” are different for each woman.  The trick is to address all of the kinds of stress that play a role in HA, and to focus on the type of stress that caused your problem in the first place.

For example: say you recently dropped from 130 to 110 pounds.  The primary problem — the thing that if it looks like a duck and quacks like a duck, it’s a duck, so stop fighting the reality of your weight loss — is that you lost too much weight too fast.  Your body couldn’t keep up with your changing leptin levels.  And you likely underate calories and gave your body starvation signals while you were losing.  So that needs to take precedence.  You also, however, exercise a fair bit and have a fairly stressful life.  To that end, you should also reduce your exercise, work on your priorities and your stress level, and be sure to eat as much as you need to.  Address all of the ways in which you can increase your body’s detection of “safety.”  Focus on perhaps gaining a little bit of weight back, however, since that was your primary “problem.”  The faster you can convince your body you are no longer starving, the faster you’ll regain hormone balance and fertility.

Other women, on the other hand, might have to focus on stress, or might have to give up marathoning for a while.

HA is all about convincing your body that it’s no longer in danger.  It doesn’t need to stress.  It doesn’t need to shut down hormone production to prevent a poorly timed pregnancy.  So you have got to nourish it as best you can.  Err on the side of over versus under eating.    Dial down your exercise — particularly the sprint based kind — and do only what feels comfortable.   Stop pushing through being so tired.  Don’t wake up in the morning to an alarm after a short night’s sleep to go for a run.  Be sure to eat plenty of carbohydrates — at very minimum 100 grams of carbohydrate a day — and make sure to eat even more if you are an athlete.   Learn to move more slowly, to eat more gently, to be less hard on yourself.   Relax, eat, relax, eat, relax, eat, repeat.   Don’t eat garbage– no way!  Some women do, and find that their fertility comes back.  But go wild with your diet, and eat as much as you are craving.  Your body has been starved, and it’s important to respond to hunger signals when you have them.  That is, if you want your fertility back.

To that end, there’s a simple answer to HA:

-Eat more.  Relax more.  Repeat.

On top of that, we can get more specific:

-Focus on nutrient-rich foods that support healthy hormone production.  Liver, egg yolks, other organ meats, bone broth, leafy greens, fruits, and vegetables are all great.

-Make sure to eat plenty of fat.   At minimum 40 grams a day.  This amounts to approximately three tablespoons of your favorite paleo oil (such as coconut oil) — one for each meal.   Including saturated fat is particularly helpful since it is the backbone of hormone production.

-Make sure to eat plenty of carbohydrates.  Your body can think it’s starving if it doesn’t get enough for a significant period of time.  Eat at least one piece of fruit or serving of starchy carbs with every meal.  Make sure to do more on active days.

-Eat when you are hungry.  Do not go hungry.  Ever.

-Only exercise when you feel energetic and excited to do so, and refuel appropriately afterward.

-Do not sprint more than a couple of times a week.

-Consider eating a fuck ton of calories.  Many women have spent ages on different forums learning about what works, and debating how many calories should be eaten at any given point in time.    Some argue you need as many as 3000 calories a day to recover.  Others assert 2000.  I wouldn’t go crazy, but consider the fact that there’s a good chance you are undereating relative to your needs.

-Consider weight gain.  Anywhere from 1 pound to 10 might be necessary, or 30, depending on where you are.   How much did you weigh when you stopped menstruating?  Is it much more than where you are now?  How much more?  What else was going on in your life?  You may need to close the gap a bit between where you are now and where you stopped menstruating in order to do so again.  Each woman’s body is different and requires a different level of fat to feel safe and be fertile.

-Sleep as much as possible.  9 hours a night!

-Consider supplementation.  Magnesium supports hormone production.  Calcium is helpful with the magneisum.   Take the magnesium and calcium in a 1:1 or 1:2 (at most) ratio.  Vitamin D can support functions with magnesium and calcium.  Fermented cod liver oil will never hurt.

—————–

Which is all that I’ve got.  I know it’s a lot and also a little at the same time.  Hypothalamic amenorrhea is all about you and your body and your own particular needs.  You’ve got to think deeply about the kinds of stress you might be dealing with, and then go ahead and rectify it.

And then give it time.

It takes time to recover from this sort of thing.  Hormones don’t leap ahead of us, they follow behind, peaking around all of the corners, making sure it’s safe before they come out and play.   I can say, however, that your recovery will be faster the more you nourish yourself, the more you eat, and the more you relax.   You can go more slowly if you are fearful of the process.  This is what I did.   And it’s good — the body learns to adjust to new leptin levels over itme.  But know that it takes longer the more slowly and cautiously you move forward with your hypothalamus.

I highly recommend checking out the Fertile Thoughts forum on hypothalamic amenorrhea.   It contains 108,000 posts and counting.  Women all across the world come to this forum to share their experiences with HA and infertility.  Definitely worth the read if you’re interested in HA at all.

 

 

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Managing director of Paleo for Women and author of Sexy by Nature.

84 Comments

  1. Pingback: Overcoming hypothalamic amenorrhea | Paleo Digest

  2. Thank you for this well written article! I wish I’d had it this time last year. I switched to a Paleo lifestyle a few months before we decided to remove my IUD to TTC. Unfortunately, my Paleo diet was toooo low carb for me. I lost lots of weight. By the time I had the IUD out, I was no longer menstruating. Took me six months to gain my fertility back. Luckily for us, we conceived the very first regular cycle I had! Well on our way to a cavebaby and doing a much better job with a balanced (but still Paleo) lifestyle. Every woman needs to read this!

    • How are you doing this? I’m not paleo but a true blue mess really. Oh my.

    • Would love to hear some things you changed to gain your fertility back! I stopped BC 6 months ago and have no had a period since and we would very much like to have a baby. I know it is a combo of not eating enough carbs and calories and also this past year was extremely stressful with both of us starting new careers/jobs. Any tips would be appreciated!

      Thank you for sharing, it gives me a lot of hope

      • Hi
        I was on the same way almost 1 year. Eating paloe doing IF some days, work out running doing HIT.
        So I can help you to give my advice what has helped me to return my period back and my fertility and happy pregnancy.
        When I slow down work out it does not help I have to stop running doing HIT and I have just walked a lot doing yoga no stressful work out even one day a week no sprint relax walk yoga strech nothing else.
        Do no IF eat when you are hungry no skipping meal nor forcing yourself to do IF just because you have READ IT IS GREAT FOR HEALTH no it is not good for fertility at all. I eat more starches I mean lot more fruit squash sweet potato even sometimes quinoa or millet I am not afraid of starches anymore. So at least 2-3pieces of fruit and big starches at dinner(2 sweet potato big squashes ) I was skinny, loosing 7 pounds in low carb paleo was a lot for my body also stressfull workout. I love running HIT and workout but I HAVE TO ADMINT THAT MY BODY DOES NOT. I am pregnnat right now and very happy do not stress your body when you want baby walk eat do not stress about food, eat real food protein fat and carb too!!!

        • Awesome! Thanks for sharing! And my hearty and sincere congratulations!

  3. Thanks so much for this post! I’ve been dealing with HA for almost two years, I feel like I’m in that waiting period now where I have gained a lot of weight back (over 30lbs) and reduced my exercise but I know that every day stress is still an issue I need to address. I will say for any women out there afraid to gain weight and reduce exercise – I know how scary that thought it, I was so afraid I’d balloon back to my pre weight loss weight of 210lbs, but rather I’ve become more relaxed with food and enjoy life a lot more. I love my curves and couldn’t imagine being any other way now. HA was a wake up call for me to get back to a better balance. I am hopeful it’s just a matter of time for me now. Oh and I have heard that some people have found seed cycling helpful, would be interested in your thoughts on that.

  4. Now the question is: How in the world do you eat a fuck-ton of calories on autoimmune paleo with very limited fruit (due to candida issues, which I understand are extremely common)?? Sadly, there is only so much meat you can eat.

  5. Thank you so much for this Stefani! I’m going to really focus on trying to reduce the stress I put on myself. The perfectionist in me needs to die b/c she’s messing up my hormones and fertility. This article touches on the very truths that any PCOS/HA (or healthy/normally functioning!) woman needs to face especially in this world of constant comparison on who’s the fittest/skinniest/strongest/smartest/whatever.

  6. Great article! I’ve been struggling with HA for 18 months and have not recovered yet. I’ve gained a lots of weight and keep gaining. I am not exercising anymore (no cardio, only light strength training a few times a week) and eating lots of everything and lots of fat. I might have to increase my carbs amount. My starchy carbs are mostly bread/wheat products, sometimes some beans and potatoes. Hormonal levels are back to normal but still no periods… Time and patience are key but it’s hard not to think about it.

  7. VERY well written, thanks for that. Also I just discovered your website and I LOVE it. I love what you wrote in your Mission Statement – I think I need to re-read it. Much love to you.

    • That mission statement is one of my favorite things I have ever written. Thank you. :)

  8. Hi “Pepper” :)
    I’ve read your blog for a long while now and am…lost. I very much admire your writings and respect/trust them . You seem intelligent and well-researched/educated. I’m 32 and my gut-metabolism-hormones are a MESS…not overweight but chronically fatigued and not exercising and …binging every.single . night. I feel like its’ too late and I’ve gone “too far” and all is lost. If you could email me that’d be great. I emailed you, but I never know if spam catches me or not :( Please do email…would SO appreciate it…need just some thoughts and ..a friend. (and this article very appropriate for me in a way).

    • Hi Dee,
      First, know that I and this whole community are behind and with you. I mean that.
      Second, in terms of advising, I recommend checking out the fantastic women who ahve been on my podcast at http://paleoforwomen.com/our-stories-the-podcast. Alex and Becky in particular take real clients, but everyone on there has professed a desire to help any women who are feeling lost or messy. And trust that you will get there. Super hard to do, I know. Much easier said than done. But it’s all a journey. Two steps forward and maybe six steps back, but that’s okay. Eyes on the future. You’ve got this, and we’re with you. <3

  9. Great post! I dealt with this issue for years, eating paleo and everything.
    All that you said was spot on except I don’t agree with your carb recommendation. I’m sure this is perfect advice for many, but then you got people, like me for example, who get their cycle back by actually going ketogenic with their diet. It took upping the fat and actually lowering the carbohydrates to flip the internal switch over here.
    Its yet another complication to something already so complex-that we women are all sssoo similar, yet ssssooo different!:)

    • Hi Ashley,

      How long after upping your fat intake and lowering your carb intake did it take to flip the switch? I have HA and hypothyroidism and I believe this may be what will help me. I’ve been eating this way for a week and feel great.

      Thanks! Hope you are well!

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  11. I love this. So so much. seriously–eating a fuck ton of calories and RESTING is the sanest, simplest advice anyone could possibly give, and yet it’s the least likely advice you’ll see pretty much anywhere on the internet.

    The question I’m struggling with now is, what happens when you’ve eaten a fuck ton of calories, massively dialed down the exercise, included more carbs with each meal and gained back 20 lbs (which is 15 lbs heavier than you were when you lost your period to begin with)?

    I guess the stress piece is going to be the hardest to finally heal…it’s definitely a frustrating process (which, ironically, leads to more stress). What do you do when it seems like the cycle will never end (and that you’ll never get your cycle back)?

    • Take a nap.

      I’m not kidding! Over the course of several months, I actually lost weight but did my best to eat when hungry and stop when full, and make sure my leptin sensitivity was as good as possible, as well as radically reduce my stress load. My hormone levels came back up.

      Here’s another idea:

      Have sex!

      Might we actually “lose” it if we don’t “use” it? I don’t think so — but I DO think that we can regain some hormone balance through happy sexual activity. Sort of knock some things loose.

      Another one:

      Consider a provera period. Sometimes women just don’t start menstruating again even though hormone levels have come back up because the corpus luteum is too thick or there is some sort of “blockage” of sorts hanging out in the reproductive cavities.

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  14. Thanks for this post Stefani! I have been on a pretty rough HA journey over the past year and a half. In April of 2012 I went off of bc and only have one very light period over the first year. At about the same time, my husband left for a year long deployment and my parents split after 32 years together. After several visits to the gyn without answers and a chronic sinus infection (lasting almost 6 months) I looked into other options and stumbled upon your website. I kept reading about incorporating more carbs but I was afraid to do so at the cost of gaining more body fat (ironically stressing over eating less carbs/calories was probably making my body hold on to what I was eating). In may, after being told the only option for me would be another sinus surgery and still not having a regular cycle I did some more research and found cranial sacral therapy. I am not sure exactly how it works or if maybe it is just the mental trick I needed to get myself to relax but since i started going my cycle has come twice, I no longer take any sinus meds, I’m okay with eating more carbs and off of my anxiety medicine. I would highly recommend this to anyone with a situation like mine! I’m hoping to see continued improvement…thanks for your great posts and encouragement!

    • Thanks for your experience and insight, sincerely. The more we can learn from each other the better.

  15. I am 22 years old and have had my period for a total of one year of my life. I struggled with an ED and at 5’7″ 87 lbs I wondered if I would ever get back to normal. I am now back to my healthy weight where I first started my period buuut… Still nothing… How long should I wait until I start to get worried? I want so badly to be able to have children later in life and I am afraid that the damage is too much

    • I recommend checking out the forum I linked to in the post. Many women have different experiences…some having to go above their former weight to get their periods back at first… then equilibrating back down gently over time…. focus on eating when you are hungry and stopping when you seriously good and full, and minimizing disordered behaviors. One year is in fact quite small for a lot of HA sufferers who recover in time to have children, so have lots of love and patience and forgiveness. You may want to consider doing a ‘provera’ triggered period in order to see if that gets things going after a while.

  16. Hi Stefani,
    I am wondering if you have any insight with my situation. I nursed my son for 22 months and stopped 6 months ago. My period still has not returned. I had my thyroid tested and the results were that it is normal. I was told to wait it will come back but I am not digging that answer. I assume the same principles you mention apply to me, eat more carbs, exercise less, supplement with magnesium (I think I will add that to my regime) . I was just wondering if waiting answer is legit or do you know something more?

  17. “-Consider eating a fuck ton of calories.”

    WHAT?!!

  18. Thank you so much for this post and for all your work. As I said to my boyfriend, reading it is like hearing your mother tell you everything is going to be alright.
    I was wondering if you had any thoughts on the use of Maca Root for help with hormone regulation? I’d heard it helped regulate cortisol levels and in turn reproductive hormones. Also I have been diagnosed with HA but because I don’t want to get pregnant at current, my doctor put me on birth control to help prevent osteoporosis. I’m trying to put what you’ve advised into effect but what are your thoughts on OCP for women who have HA. Does it down regulate estrogen like soy does? Anything else I should do to help prepare my body for pregnancy in the future?

  19. I had an ED and was eating “normally” for 2 years without getting my period back. I read some of Matt Stone’s articles on refeeding and decided to try it. I started getting raw milk and found I absolutely craved the stuff. I would make smoothies with it and would have 2, 3 or sometimes 4 a day in addition to meals. I gained quite a bit of weight, about 30 lb over my “healthy weight”, but my period came back within 2 months and has stayed regular ever since.

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  21. Thanks for sharing this! After struggling with amenorrhea for almost a year and a half, I feel compelled to share my story. I’m 26 years old and went through a period of excessive dieting and exercising (obsessive calorie counting, cardio everyday). After months of being extremely depressed, irritable, low libido and just plain unhappy I decided to stop my birth control. Only to find out that my periods had stopped. In an attempt to find answers I consulted my ob gyn, a functional medicine practitioner, an acupuncturist and a fertility specialist. I avoided all my food sensitivities, gained 20+ pounds, drank all my herbs and took my BBTs but no periods. My fertility specialist prescribed me 3 weeks of estradiol and 1 week provera and that was the only time I got my period after a year. But when I didn’t get it again after that, I gave up. I thought I would never get my period again naturally. So I stopped seeing my acupuncturist, ate whatever I wanted, stopped exercising and basically said, “Fuck it”. And a month after that I got my period. I know it sounds too good to be true but trust me gaining weight and all the anxiety that comes with that was one of the hardest things I’ve ever had to do and still is. But knowing that my body is healing makes it worth every pound. There is a light at the end of tunnel!!

    • We have such similar backgrounds! I am 26 suffer from low libido, no cycle, and only get my period when I do the provera challenge. I don’t cycle naturally. How did you finally get to the “just fuck it” point? I still work out, try to eat healthy, and am very conscious of my weight.

  22. I’ve had HA for the past 6 years. I’ve tried gaining 10 lbs, reducing stress (hard when you are a midwife), eating more carbs, eating less carbs, exercising differently…nothing has worked so far. After hitting the wall, finally, suffering from serious adrenal fatigue, I finally sought out the help of a functional medicine doctor. Turns out I have little to no estrogen/progestrone/dhea left in my system (tested via blood/saliva), my amino acid profile is deficient in almost everything (I’m not converting food into amino acids) and my cortisol curve is flat. I also found out I have osteoporosis in my lumbar region and osteopenia in my pelvis (at the age of 33). The MD said if it wasn’t for my spotless paleo diet, she couldn’t see how I could function!
    I’m starting bioidentical estrogen/progesterone/7-keto DHEA this week in addition to IV nutrition therapy and compounded amino acids. Do you have any suggestions to help aid my healing? Any experience with these bio-identicals? I tried traditional HRT about 5 yrs ago and didn’t last 2 wks on them…they were HORRID and felt totally unnatural. Any advice is much appreciated. Thanks for all that you do!

  23. I am thrilled to have stumbled on your website today. I have NEVER heard of HA before. I intend to research it more but wouldn’t be surprised to find I have it. I began having hot flashes at 30 y.o. and eventually was found to have high FSH levels and diagnosed with what they now call Ovarian Insufficiency.

    The specialist put be on BC to prevent Osteoporosis and even though I asked for other options wasn’t told about any. I highly recommend anyone being told to do this look for other options.

    A couple years laterI had severe sleeping issues eventually followed by brain fog,memory loss, concentration issues, clumsiness and more. I thought all these symptoms were due to the sleep deprivation. After a year and a half I found out about bio-identical hormones and made an appt to see someone to see if I could use those rather than BC for the ovarian failure. Before my appt a friend told me her mother had some of the same symptoms i was suffering with during menopause. That is when the light came on.

    Sure enough my hormone levels had tanked. It took 6 months to get them to “normal” levels and at 38 we are still tweaking them (usually increasing). I take 4 hormones every day and have integrated things like Energy Medicine to disengage my fight or flight (stress) response. It is still a continual journey for me. I’ve been out of my progesterone for about 11 days now and even though I’ve been using an essential oil Progesterone blend to try to make up for it I have no energy and am finding I need way more sleep than usual.

    I struggle with having periods every 2 weeks, this has been common for more than 1/2 the time I’ve been on hormones and hopefully we’ll eventually figure out how to “fix” it.

    Anyway, I’m thrilled to find your very informative articles and am looking forward to reading more about HA. (maybe I will stop feeling so frustrated at the 20 lbs I’ve put on in the last 9 months.) lol

  24. I was reading some of your posts a few days ago. You had posted about iodine being good and the fact that iodine might make you sweat. I notice that I had not been sweating for many years, Recently, I started spending 1 hour in the sun (1/2 each side, front and back) to get real Vitamin D, and after about 5 or 6 sessions, I can say that I am sweating again. And now I can sweat not only in the sun but also in other activities that require effort. It seems that the sun gave me the ability to sweat. Knowing that sweating is very important to eliminate toxins of your body, I am thinking that besides vitamin D, the sun has an important role in detoxification. Most people as they age, they stop getting enough sun. I am surprised by the good effect that sweating has had in my skin too. It caused a deep cleaning that rejuvenated my skin. That is my contribution from my observations. Thanks for sharing health information in your site.

  25. Great Post! Man did it take me forever to get my period back. 5 years between the ages of 25-30! I definitely had to gain back A TON of weight, and now being a bit overweight is slightly uncomfortable to me, but nothing compared to the hell I put myself through with eating disorders and being totally inflamed, sensitive and devoid of hormones through my late tens and twenties.

    Truth be told I look back on what I thought was a normal weight and I was DEFINTIELY underweight, for many years. Body dismorphia is a real thing, whether its self imposed, brought on by family or other social pressures, it can reeeaalllly fuck up your head.

    I ended up gaining 60 pounds. SIXTY, and now weight at least 30 over the most I have ever weighed before….and I am still just chunky and not really all that huge.

    The only cavet I have is for ladies with SUPEr sensitive blood sugar, there is definitely no way I could eat fruit or a starchy veggie for each meal, it would totally blow my BS out of the water. My period actually came two weeks after the my weight was up and I dropped the few carbs I was imbibing in. I had been hanging onto carrots and parsnips because I worked on an organic carrot and parsnip farm, as soon as those went out my blood sugar stabilized and my moon time returned in all of its glory!

    7 moons later and I am feeling the surges and cycles of hormones again! It’s truly like puberty, with thoughts and emotions getting a little skewed from time to time and its beautiful and amazing to have gone through all of this and then back. I feel more feminine then I have in my whole life. I love my boobs and ass, although I miss having as much muscle as I used to, because without hormones and with being super skinny in the past and letting it get so out of hand that I was very much at the verge of adrenal failure, I lost a lot of muscle tone. So much for all those times I pushed myself when I should have been resting, relaxing and recognizing and honoring that my energy was being drawn from the wells of my anxiety and not truly balanced energy. I wont do that again, I can tell the difference now.

    My weight is the last thing on my mind, being balanced, fertile and healthy definitely out weight giving a shit what size jeans I wear. Not only did my fertility and mensus come back, I am so mentally stable I don’t really recognize myself. I am calm, happy, pleasant….my life is still shitty as always but it doesn’t phase me……my body feels safe, it knows its safe, and my mind reacts accordingly:) Amazing! Thanks for helping women along this journey and sharing your own Stephani!

    • Just a little side note, I didn’t loose weight when I stopped all carbs, I just ate more fat :) Now I can do one meal a day with carbs, dinner usually has jicama and that’s plenty.

      Taking a good food based multivitamin helped, as did eating a ton of seaweed, especially dulse, which is high iodine, and taking some of the other cofactors(zinc, selenium, b vitamins, vitamin c). I truly believe orthomolecular nutrition is key to allowing your body to heal and replace lost or imbalanced minerals.

      I tried all types of other shit in the beginning, DHEA, desiccated glands, etcetcetc…those only made my body more out of balance and confused.

      Focusing on whole and raw fats, including raw egg yolks and dairy(and meat! but I’m weird) makes me feel truly vibrant, making sure they are local and organic is the only way to know they are safe and wholesome.

      Moderation and consistency are also some of the best medicine, as well as chilling the fuck out and lowering perfectionist expectations….

  26. Thank you so much for blogging about this! I had HA in 2010/11 and there was almost nothing on web as clear as this blog post about the causes and the best treatment. I am so happy to see people giving and accepting advice to JUST EAT AND NOT EXERCISE. I finally followed this advice in 2011 after 7 months of HA, got my period back and got pregnant on our first try.

    Now I am TTC again and post breastfeeding my body is off again. While it is frustrating, I am trying to remind myself that it’s my body’s way of saying that it needs to be READY to carry a baby. While it is SOOOO tempting to jump back into hard working out & dieting, I know I need to eat more, move less (ha ha) in order to get back into baby making shape.

    That being said, I am trying to eat cleaner since giving birth so I am trying Paleo. What carbs are the best to eat daily? And should I aim for 100-200 carbs a day? Just want to be sure that I don’t under carb myself. I think my body likes this extra fat and protein but with all the extremely low carb bloggers out there, it is hard to figure it out.

    Thank you for being so focused on women.

    • Also wanted to mention something – for people who have had EDs in the past and now are struggling to get pregnant.

      I don’t have any research on this but one of my better doctors told me that if you had an ED with HA in your developing years, (like 14-18), your brain has become even more wired to go to that shut down place. Like another poster said, it could take gaining MORE weight and exercising EVEN LESS than other women. For this reason I think it is so important to listen to your body and not compare yourself to others while trying to get out of HA.

  27. Hi Everyone,

    I have really enjoyed reading all of your comments. I had an eating disorder which caused my cycle to stop, then it came back normally, went on BC for 5 years (cycle was like clockwork due to the pill), stopped taking BC September 2009 and no cycle. Went to the doctor was diagnosed with HA. I still don’t get my period 4 years later. I would like to take the most natural route if I can. I am considering changing my diet, I do eat fairly healthy currently. Any ideas? ALL ideas would be appreciated. Thank you!

    • Steph –
      I recently read the book, Diet Recovery, by Matt Stone and it has really been helping me get my body & mind back on track naturally. I think Stephanie mentioned Matt Stone and when I researched his ideas online, his message hit home with me. He has done a lot of research and has helped a lot of people recover from disordered eating, over exercising and a slow metabolism. He basically tells you to eat when you are hungry and eat whatever you want. This will help boost your metabolism and get your hormones working again.

      Like you, when I went off the pill, it took me a while to get my period back. NOTHING worked, even meds from doctors, until I started eating A LOT more and slowing down. I got pregnant about 5 months after I stopped counting calories, eating “healthy” and running.

      I still struggle with disordered thoughts about food and body image but Matt Stone and other NON diet fans have been helping lately.

      Good luck!

  28. Stefani – I ran across your blog while doing some research on HA and PCOS and have read it from top to bottom – it has been very helpful and informative. I am 29 years old have struggled with infertility for over 2 years now. I am currently in the middle of my 4th FET (after 2 Fresh IVF cycles) and have always been a super responder to fertility meds. At this moment, I have 14 high graded, genetically tested normal embryos in the freezer. Up until recently, it was thought that I had PCOS solely because of the appearance of my ovaries. Now, my RE thinks that I respond more as HA. Really, neither make a lot of sense as I am of normal weight, not insulin resistant, and my FSH (below 1), LH, estrogen and progesterone levels are all very low. I do work out and watch what I eat but it’s not obsessive (5’6″, 145 lbs) and in my adult life I haven’t been below 130 lbs. I completely agree that doctors don’t know how these two conditions relate and have heard several times that you can’t be both.

    I recently found out that I’m allergic to gluten so have tried very hard to cut that out of my diet. Do you have much experience with gluten and its effects on HA, PCOS and infertility? I’ve tried it all, from metformin to acupuncture to cutting out carbs to eating anything and everything (gaining about 10 lbs in the process) to barely working out…nothing has worked to start my cycle. Is there anything that stands out to you as to what is going on with me?! I know you are not an MD, but you are certainly well informed and knowledgeable on these topics and I welcome any advice and insight you can give!

    Thanks in advance!

  29. Thank you!!!

    • Ok ladies I need some help! So you can see my history from above. A couple of months ago I started to eat a clean plant based diet after watching forks over knives, to see if I could get my cycles to return. During this time I went on vacation and got off the plant based diet. After reading other posts I then tried eating what I want when I want it. Two weeks later my period started!!! Know I don’t know how to eat to keep they cycle going for next month. Was it the clean eating or eating what I want?

  30. Stephanie, do you know anything about the relationship between HA, and bone loss/premature osteoporosis? I would appreciate any information you have, as clear opinions and facts on this have been difficult to come by.

    • Yes! Low estrogen is a result of HA, and is one of the primary causes of bone loss.

  31. Steph,
    It’s been a year since I last got my period. I raised my caloric intake and dialled down the exercise but still nothing, thing is I’m already 15 lbs overweight to begin with (according to my BMI) so I can’t tolerate the idea of gaining. Any ideas?

    • There may be other things at play. Stress? Gut health? Have you had any blood tests done? Have you considered PCOS?

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  33. I just returned from 7 months of being a cavewoman- living in the woods, eating strict paleo, lots of exercise, lots of fasting, lots of fun and LOTS of stress. I stopped my monthly bleeding after the first month! I also lost quite a bit of weight (age 20, 5’7, from 135 eventually to 112) and gained a lot of muscle. Hypothalamic amenorrhea sounds like my situation exactly. This article is very helpful- I am very afraid of gaining weight however!!! I’ve been very hungry since returning to civilization, have had some binges on junk foods and whole foods. I do want to gain a little weight, but in a healthy way. I am exercising a lot less, but still more active than I used to be. I am afraid that I’m just going to balloon like crazy and lose all my muscle and feel horrible all the time like I used to. I am still under a lot of stress, worrying about my health and what I’m going to do with my life. I also feel like I don’t have a lot of people to spend time with and talk to, and none that have shared any similar experience. To say the least, it is a hard time for me. Your blog has been very helpful in my search and work toward self love and optimum health. Thank you!!

  34. I am really happy to read all of these, i have been really scared lately. i was thinking that i had PCOS but i was cofused because i didnt have other symptoms of it. I have had my period 4 times since menarche(i was 16 years then), i am 19 now and its been 9 months since i last saw my period. I normally don’t eat all the time even when i may be hungry because i am scared of becoming fat, i don’t want to be fat.i have this cold that never stops and i am mostly tired, i do my exercise 5 times a week and i barely get 6 hours sleep every night. From all you have put down here ,i think i am going to give it a break , eat, relax, though it will make me feel lazy, i don’t mind, i wanna be a mum someday.thank you so much, keep doing what you’re doing.

    • Yes! Relax. More calories, more carbs, more fat, less exercise, less stress. Repeat. :)

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  36. Hi all,

    I’m in a similar situation. I had two years of strict dieting and 7/days a week intense exercise and haven’t had a period since the beginning. For the last 3 months I have been eating 2500 calories a day minimum and walking 30 mins a day with a little yoga here and there and still nothing :( I have gained nearly 10Kg now. Stress levels are not too bad. I’m at a loss with what to do…

    • Give yourself some time, Jess. I needed years. Nutrient deficiencies often accompany such trials. I also needed to learn how to eliminate stressors from my life. And gain… I gained thirteen body fat percentage points. That’s not to say that’s what you have to do, but just do your best to always eat when you are hungry and your body will find its sweet spot over time.

      • Thank-you. I need to hear this today. I’m just lost with what to do.

        I’m wondering info if I eating enough- I eat between 2000-2500 a day of all foods. I have dropped paleo for now….and I have reduced waking to every second day (not sure this will make a difference) but is it just a matter of time or is there any thing else you can suggest?

        I’m not sure how much body fat I have gone up but I was 14% and since then have gained now 11Kg.

        • Seems like you’re doing it about right, Jess. Make sure to include some good vitamin rich foods like greens with coconut oil and organ meats like liver. Other than that I would just give it some time and see if any changes occur.

          • Thank-you.

            Just another question. Did your weight stabilise? I seem to keep gaining and that is getting hard as my bmi is now 24-25

  37. Hello,
    I am 19 years old and have not had my period for about 9 months. I had been very regular before this. About exactly 9 months ago, I lost about 15 pounds that I put on freshman year of college by eating a low-carb diet. I still ate plenty of food, lots of vegetables, but just cut out the desserts, pastas, breads, etc. It worked great and I was very happy! But my periods have stopped altogether. My gyno says its stress-induced. I took a low dosage of progesterone to stimulate my period, but it did not work. I am now on a higher dosage to induce my period. I am very upset, however, because I have put back on 10 pounds that I had lost. I am still eating low-carb though – why is the weight coming back? Is my body trying to gain weight to allow me to get my period? very confused and frustrated.

    • Hi Jen, basically the exact same thing happened to me. I lost the “freshman 15″ by eating clean and exercising more. Progesterone also didn’t work for me…It will not work when your body isn’t producing estrogen. I’m not sure why our bodies would suddenly stop producing it. Hormone therapy made me feel awful, so I’m not doing it anymore. I’m trying a high protein, high fat, low sugar diet right now, but do need the complex carbs, since I’m mostly vegetarian and need those amino acids. I have not gained any weight, though. Have you had any success with any diet you’ve tried?

      • YES. Eat the carbs! Exercise less. Eat more. Repeat.

        • Tracy and Stefani,

          I have recently been put on Birth Control in order to regulate my hormones/get my period back on track.

          I am continuing to low carb, but it is not working. I have gained back the weight I once lost doing a low carb diet, so I am extremely frustrated.

          Do you think that BC just takes a couple of months to regulate my hormone levels, and that low carb could work again? VERY frustrated and discouraged.

          • It’s possible – though it’s not the carbohydrates to focus on. It’s the BC pill. Estrogen, particularly in a woman who has been bereft of estrogen due to HA, can cause weight gain. As someone overcoming HA – which I am assumnig you are – I can only say weight gain will in all likelihood help your health, though personally I’d do it without the BCP if I wanted to be independently healthy

            • True. Do you think once my hormones are regulated and I go off the BC, then it could be easier to shed the weight I have gained? I did gain most of the weight prior to starting BC, which makes me think it is not the BC causing the weight gain.

          • Did you gain weight from being on the pill itself or from stopping low carb? I eat low carb as well and am considering birth control as a way to menstruate again

  38. This is the best article I could find about the condition on Internet and thank you for taking time to write it. I struggle with it too and due to the work, it is difficult to admit that there are limits to one’s energy.

    It is a brilliant article. Thank you. Every day is an opportunity to start differently.

  39. Pingback: Hypothalamic Amenorrhea (HA): Part 1- Background | Finding My Happy Medium

  40. I must also say thank you for this post. Still working on getting my period back which has been absent for 1 year now. It stopped when I stopped taking pills, so I think that is one factor. But I have also lost weight non stop for a year, but I’ve been super healthy all the time so part of me feel like it’s so unfair! I have been stressed quite a lot though that is what I’m working the most on now and I’m not trying to loose weight anymore. Working out 3-5 times a week, ballet beautiful exercises and running sometimes. I have decided to swap to yoga soon and walking instead to really slow down even though it’s not what I want. Oh well health comes first, hopefully this will help. I am also seeing a naturopath right now who’s giving me herbs and other directions. Fingers crossed!

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  43. Your stuff is AMAZING! One question though: I’ve always been a tiny thing, and I got my period at 13 only weighing about 100lbs I’d guess. (at 5’4″). People actually thought I looked anorexic (instead I just ate junk food and remained scrawny.) At about 15, after the divorce, I suffered with various disordered eating patterns throughout my life. My periods were irregular over that time, sometimes seizing for 3 months (when I was really stressed), but cramps were barely noticeable and the cycles were light. By 23, I had exhausted my resources apparently: I had adrenal fatigue (low cortisol) & subclinical hypothyroidism. 18 months later with help from a fan-freaking-tastic integrative nurse here in Colorado, hormones are back online. I get my period but the cycles are not regular. My cramps are CRIPPLING like NEVER BEFORE. They’re absolutely the worse. I PANIC when I think my period is coming.

    I’m wondering .. Why would this be??? I am eating closer to my energy levels, about 1800-2100/day. Still paleo. DEFINITELY not as stressed, I am a happy girl! Adrenal tests came back normal (morning is still lower than I want, but better and in normal range,) thyroid hasn’t been checked yet but I feel better and my temperatures are 98.2-98.6+ every morning. I’ve gone from 116lbs to 126lbs over this journey, and it’s mostly in my belly, but most certainly also in my breasts. Would like to lose the 5lbs of belly but it feels IMPOSSIBLE to diet. I can’t sleep at night if I eat less than 1700/day. Absurd because I used to eat 1400/day and feel fine. UGH!

    Anyway – WHY would menstrual cramps increase SO horribly if everything else seems to be “online”? Maybe my body is just being revengeful and making me suffer for starving her for so many years. ;-) Can’t we just be friiiiieeendsss? :-(

    This comment was WAY longer than I thought but, you know. Girls are too good at going off on tangents. Thanks again for ALL you do!

    • Hi! A couple of possibilities. 1) Perhaps your body is just in an “adjustment” period since it hasn’t had such high estrogen levels (if at all) before. You may just need to give it time.
      2) It’s POSSIBLE you have endometriosis – though not likely.
      3) Perhaps you have some inflammation you need to deal with. Have you tried supplementing with magnesium? Are you making sure to eat some carbs every day? Also, NO NUTS. Nuts are killer for women with cramps.

      4) GOOD. This is all wonderful news. Don’t sweat the whole “I have to eat a lot to sleep” thing – I have the exact same “problem.” This is just our bodies refusing to go back to the punishing routines they had to live with before. Go on and eat as much as your body craves!

      <3

      • Stefani,

        Thanks for your note. Another quick question, I have just been put on Birth Control in order to induce a period (it has been a year). I have still been following a low carb diet, but have continued to lose no weight. Low carb/ Paleo has worked wonders for me in the past, I am frustrated as to why it is not working for me anymore. Do you think when the BC kicks in, my body weight could fall back to what it waS? What could be the cause of me gaining weight on a low carb diet when i lost 15 pounds before? Please give me any insight on this subject!

  44. Pingback: My HA recovery journey: why I will eat more, exercise less, and relax more | journeys of 10,000 steps

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  46. Hi,

    I’m 19 years old and started working out and eating healthily about a year ago. I’ve always been regular but 5 months ago my periods stopped. I lost about 20 pounds over the year and now i’m at a healthy weight for my height ( 105 pounds and I’m 5’1), my BMI is 20 and my body fat is 20% so I don’t know why my periods have stopped. I’ve stopped counting calories a month ago and stopped exercising but my periods haven’t come back. I’ve done blood tests which came out normal. I’m really stressing out about this as I need my periods back soon. Do you have any advice about why it’s missing? Thanks!

  47. Pingback: Get Your Period Back: 5 Tips For Recovering From Post Birth Control Syndrome

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  49. Thank you for this post. I was diagnosed with HA in September and am struggling to get things back on track. I haven’t lost any weight recently, I eat clean, eat when I’m hungry and allow myself rest days and “cheat” days where I eat whatever I want. I’m not sure of my body fat percentage, but I’m about 102 pounds, my BMI is about 18, and I have a good amount of muscle. I am very athletic and eat a largely vegetarian diet, but will eat seafood or poultry about once or twice a week. I also take protein, fat and vitamin supplements.

    Do you think maybe I’m not getting enough protein as a vegetarian? I’ve also struggled with failed relationships and jobs during this time…so maybe it’s partially psychological?

    My doctor says I need to gain weight, but from what I’m reading here that doesn’t work for everyone. I don’t really want to stop being an athlete…does anyone have any suggestions about what worked for them? Progesterone didn’t work for me, since I’m not producing estrogen. I know I am mentally stressed, but don’t know what to do about it.

  50. This article is awesome! I have struggled with HA for awhile, starting in high school from some family/school stress, and disordered eating/excessive exercise. I then started birth control to ‘regulate’ my period only to make things much much worse. After being on bc for 10 years, about 3 years ago I decided to stop bc and heal my body with the help of a holistic dietitian. It’s been a long, tough and expensive process but I have finally had my own period for 6 months straight! I’ve done lots of minerals, immune building supplements, bioidentical hormones, detoxification/gut healing, gained about 15 pounds (115 to 130), stopped cycling and cardio and incorporated weights and yoga, and lots of stress reduction. I feel so much better :)

  51. Thank you so much for this helpful article. I’ve been struggling with my hormones for about 6 months now. This was following an intense period of stress, weight loss and quitting hormone-based contraception. I will take your advises and see how they work. Thanks again for sharing your insights!

  52. Hi Guys !
    Seems that my case is probably the worse of all ….I’m 38 & my period stop when i was 20 yes 18 years ago!!! I eat fairly well , balanced although not very well structured . I also have under active thyroid , any advice in what can i do to get my period back or is been too long ? I wonder if there is any hope to get my period back ….

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