Hypothalamic amenorrhea (HA) is a long title to describe a condition in which your menstrual cycle stops for a few months.
This may sound like a dream to many women (I mean, no pain or mood swings!?), however, it can actually have some pretty serious long term health outcomes including on performance, gut health and fertility.
What exactly is it?
To break down the long title:
Amenorrhoea is simply means the absence of a menstrual cycle
Hypothalamic refers to the hypothalamus which is often referred to as the control centre of the brain as it produces a number of key hormones.
What happens is that your hypothalamus stops producing a key hormone, gonadotropin-releasing hormones (GnRH). GnRH in turn, reduces the amount of other essential fertility hormones to be produced.
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH) to
This causes menstruation to stop but can also have other flow on effects to your bones and other body systems.
Why does it occur?
HA occurs when your body is under stress and isn’t able to support all of it’s processes and so it begins to shut down the least important systems for example, the reproductive system. This stress could be emotional, over exercising or under-fuelling. We often see HA among those competing in sports that have really high energy demands or are competing in aesthetic sports where there is a pressure on staying lean (leading to energy restriction).
How is it diagnosed?
Diagnosis will involve booking in with your women’s health GP and your gynecologist. It will be important to rule out any other possibilities for why your periods have stopped. Below are some common tests that your medical team may run:
Getting a blood test to assess your FSH and LH (as well as a couple of other hormones to rule out pregnancy or other causes) will be a good place to start. If FSH and LH levels are low, this could indicate that you do infect have HA.
Your gynaecologist may prescribe progesterone to induce mesntrual bleeding. If your body is in a HA state, it won’t actually respond and you won’t get a bleed. This is another way to confirm that it is in fact HA that’s the cause.
How is it treated?
Treatment will be individual, and tailed to the key factors that are causing HA for you. In general though, it is likely going to include focussing on the lifestyle factors that were the route cause.
In general, it is going to be about rebalancing your hormones and working on any mindset factors that may be going on in the background.
Many people with HA aren’t eating enough to fuel their bodies for the exercise and training that they are doing. Working on rebalancing energy and carbohydrate intake is an essential part of recovery. Due to the hormonal shifts, which can also impact other tissues/systems such as your bones and digestive system, it may also be important to look at particular micronutrients. I recommend getting a DEXA scan done at the start of recovery. This is an accurate way to assess your bone mineral density as well as your body fat % and muscle mass.
The amount of fuel that you need is going to be very individual, however, by using the information from your DEXA scan, you can begin to get an idea of requirements and whether low body % may also be having an impact. As a starting point, I’d recommend eating at least 5 times per day and ensuring that each meal and snack is well balanced with protein, fats and carbohydrates. Make sure that you consume a sizeable serve of carbs pre and post training, as carbohydrate (independent of energy/calories) can contribute to HA.
On the bone front, ensure that you are consuming plenty of calcium-rich foods. Dairy is a perfect option as it is high in calcium as well as protein and carbohydrates. However, if you can’t tolerate dairy, ensure that your plant-mils are calcium fortified. Look for 300mg of calcium per serve.
Depending on where your recovery journey is starting, you may experience some gastrointestinal discomfort as you begin to increase your food intake. This is normal and temporary. You may experience bloating, abdominal pain and some bowel changes. Don’t cut foods out, continue to eat small frequent meals and chew your food well. Essentially, you’re stomach is learning to digest food again and cutting food out, will only precipitate the problem.
As HA recovery is all about reducing stress and rebalancing hormones, it is often recommend to strip your exercise right back. However, we recognise that exercise can also be an outlet for many people and a way of coping with stress and anxiety. We hear you and it’s not easy. If this is you, we 100% recommend chatting with a psychologist with knowledge around HA to develop some strategies to help you cope with stress in the absence of exercise. Although, your normal training routine might be out, yoga and pilates are very much on the table! These are great ways to keep moving your body but also learn to breathe and even work on some of those stabilising muscles in the process.
But what about your bones? Doesn’t exercise improve bone mineral density?
You’re right, weight bearing exercise is important for your bone health, however, only in the presence of enough hormones! If you are training hard in the absence of these hormones, you could be doing more damage than good. Therefore, we recommend working closely with an accredited exercise physiologist or physiotherapist to recommence training after 3 regular menstrual cycles (a sign that your hormones are back up and running).
Stress & Mindset
Stress is the adaptive response of our body through all its homeostatic stems, to external and/or internal stimuli that activate specific and nonspecific physiological pathways.
HA cocues generally after severe stressful conditions and intense emotional events.
We recommend working with a psychologist or counsellor who understands HA and who you feel comfortable with
It is also important to address the core reason for the stress or low energy availability. For many people, these are just symptoms of a tense relationship with food. The mindset behind disordered eating can make recovery from HA tougher and if you feel that this may be you, working on your relationship with food and your body should really be the main focus of treatment with restoration of your menstrual cycle simply a flow on effect.
HA recovery can be tough but it is possible. Surround yourself with a knowledgeable team of experts (GP, specialist, dietitian, exercise professional and psychologist) as well as supportive friends and family who can ride the journey with you. If you have any further questions, please feel free to reach out.