What is Hypothalamic Amenorrhea?

One thing I wish I could go back and know back when I was struggling with my relationship with food that I know now is how serious it is when undereating and overexercising cause you to lose your period. Well, I didn't quite realize that the reason for my lost period was due to my food and exercise habits. But I did have a hunch. There was always part of me that just blew off the fact that my period hadn't come for 5 years on my own. I was having a birth control bleed, which isn't really a period because you don't ovulate on birth control. But one thing I wish I'd fully understood was that not having a period wasn't a normal thing. And, in fact, it was the biggest indicator that my efforts at being healthy were actually unhealthy. Let's talk about this a little. Let's talk about losing your period due to undereating and overexercising. It's called hypothalamic amenorrhea.

WHAT HAPPENS IN YOUR BODY TO CAUSE HA?

Hypothalamic amenorrhea, when we break down the words, tells us a little more about what it is and how it occurs.You have "Hypothalamic" meaning regarding the hypothalamus. And you have "amenorrhea" meaning not having a period.What happens physiologically here is that your hypothalamus, a small region in your brain, stops producing a key hormone in your menstrual cycle, Gonadotropin-Releasing Hormone (GnRH), due to physical stress, emotional stress, or both. Essentially, your body says, "If I'm stressed out I'm in no place to have a baby".Even if you're not planning on getting pregnant anytime soon, your menstrual cycle is still such an important process your body goes through each month, give or take a few days. Some even refer to it as your "5th vital sign" or your body's "monthly report card".So your stress, whether emotional or mental like you'd get from a really stressful job or from stress with college, or whether physical stress like you get from being on a restrictive diet, not eating enough, or exercising too much, it's all the same to your body. And your body gets the signal that having a monthly cycle is too risky. That risking getting pregnant during this state of stress wouldn't be good for you or a potential pregnancy.So one day you wake up and...no period.Maybe you were shocked to realize you were late to your period, that first time that you started to notice hormonal changes. You did a pregnancy test...nope, ruled that out. And you think back and the only thing that's changed is you've taken up running and trying to eat a little better...for health. There's nothing wrong with running and eating healthy, but one thing I want to highlight here and stress is that every woman's body is different and every woman's capacity for handling stress of any form, in this case exercise and a lower caloric intake, differs person to person. 

LET'S TALK STRESS

Stress is something we all deal with. In some ways, stress can actually be good for the body, as is with exercise. But like I mentioned above, we each have a threshold and often we see issues with the body tolerating stress when that stressor becomes chronic. Our bodies are well equipped to handle acute stress, which is stress that comes on us and then pretty quickly goes away. Think stress of a major project at work or school. It's not something you're having to deal with constantly. Now things are different when everything about work and school stress you out and you're living in stress. That acute stress then turns to chronic stress.Exercise is another area where stress is good. We need stress to be put on our bones through movement to keep them strong and our muscles need to be strengthened with a little stress through weight-bearing exercises and weight lifting in order to protect our body's alignment. But even good stress like exercise can be taken to the extreme as is with over-exercising.How do you know if you're over-exercising? Well, one big indication is your missing period if you've seen a doctor and they've ruled out other sources of a missing period (HA is often a diagnosis made by ruling everything else out). In the past it was thought that HA only affected athletes, but we now know that it can occur in anyone whether you're training for the Olympics or following a "Couch to 5K" program. The important thing to remember is that you can't compare your capacity for exercise with someone else's. Again, our tolerances are all so very different. You want to tune into your own body and decipher the signals it gives you to best know how to care for it.The same goes for eating. You don't have to have a diagnosed eating disorder to be struggling with HA. Any form of restrictive eating ranging from trying to eat "better" but ending up not eating enough to dieting to struggling with anorexia nervosa can yield the stress it takes to lose your period. 

THE EQUATION TO REGAIN YOUR MISSING PERIOD

Getting your period back if you have hypothalamic amenorrhea comes down to this equation...Eat more, exercise less.Getting your period back involves decreasing and essentially reversing the stress your body is going through with not getting enough calories and not getting enough nutrition as well as the stress from too much high-intensity exercise. Emotional/mental stress can also play a role in your missing period, but more often there's also the inclusion of the other two factors...food and exercise.So in order to get your period back you want to first off figure out what your triggers are for your missing period. Is it that you've not been fueling your body enough, with enough calories and/or enough nutrition from specific food groups. Are you cutting out or decreasing carbohydrates or fat from your diet? Are food rules keeping you from eating enough and getting enough energy (aka calories) from food? Does exercise also fit into your equation? Do you have a strict exercise schedule that has you doing a lot of cardio? Is there psychological stress in your job, your home, your school? All of these are factors that can interfere with a good, healthy menstrual cycle. 

IT SOUNDS SIMPLE...BUT I KNOW IT ISN'T ALWAYS AS SIMPLE AS FOLLOWING AN EQUATION.

It's tempting to want to say, "just eat more, exercise less". But I know all too well, from my own experience, that this is a lot more difficult than it sounds. I know first hand that there are often a lot of barriers and things we have to work on within ourselves, within our mind, to be able to do these two "simple" tasks. For a lot of us this means tearing away rules we have around eating. It means accepting our bodies and maybe even being ok with gaining weight if we're at too low a weight for our bodies to feel comfortable and safe having a period.This is where it may be best for you to work with a professional, like a coach or nutritionist who does coaching, to help you work through some of these barriers. This is one of the things I work on with my clients, helping them not only to get their periods back and be physically healthier in that way but also to be healthier in their mindsets about their bodies and about food so that they can have more sustainable results. I can't stress this enough...get help. And know that you deserve help no matter where you're at. A lot of people feel that they have to be "sick enough" and have an eating disorder in order to get help. That's not the case. I want to end with this. I know that having a period isn't always the most glamorous thing. Maybe you've even enjoyed not having one for however long. But your period, as I mentioned before, works as sort of another vital sign of your health. As women, it's such a great tool to help us know how we're doing. And learning more about our cycles so that we can be experts of our bodies is just another wonderful way to be able to practice tuning into our intuitions and care for ourselves in a healthy way. I like to nerd out about our cycles which I know isn't for everyone. But you owe it to yourself to know at least a little about what's going on in your body. If you want to learn more about your cycle I wrote a blog post where I keep it super simple...you can check that out here :).And lastly, if you feel this is you...if you're missing your period and you feel it's due to undereating or overexercising or if you've had everything else ruled out by a health practitioner and they've given you the diagnosis of Hypothalamic Amenorrhea, I want to encourage you to do the hard work to get your period back. It's not always easy. It may be a short journey, or it may be a longer journey. But it will be worth it, knowing that your body is at a healthy place. Want more?? Check out my free e-book where I go more in-depth about how to get your period back and heal your hypothalamic amenorrhea.