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If you have read my first blog post, you might be wondering, what on earth is Hypothalamic Amenorrhea?
Apart from being a bit of a mouthful, Hypothalamic Amenorrhea, or HA, is defined as the absence of menstrual periods for 3 consecutive cycles, or over a time of more than 6 months, in a woman that has previously menstruated.
It is caused by the Hypothalamus (a small complex structure of the brain) signalling to the pituitary gland to stop the ovaries from preparing for childbirth due to perceived stress.
I am highlighting this word to you because STRESS is the most important driver and contributing factor to HA... but I don’t necessarily mean the running around trying to complete a deadline kind of stress (although this can totally be a reason). I am talking about any kind of adverse or demanding circumstance that causes you a state of mental or emotional strain.
The main stress factors for HA are under-eating, over-exercising and intense emotional events which cause physiological stress on the body (with or without weight loss).
Each of these stressors has an underlying commonality. Energy deficiency. A bi-product from intense stress put onto the body from over-exercising or under-eating. This means you are not consuming adequate calories in order to carry out your most essential daily bodily functions, and therefore, your brain believes you are either under attack and running away from a dangerous predator or being held captive and being starved on rations of food and that’s definitely NOT a safe environment to bring a baby into the world. Nor do you have the energy and calorific supply to be able to grow a baby healthy and consequently, it shuts off your reproductive system.
Sometimes these stressors can be so small they are not even received by your conscious brain e.g. fasting, lack of sleep, being unhappy in your job, long working hours, traffic, divorce, financial obligations, arguments with loved ones, poor self-esteem, negative self-talk, traumatic events etc. Steady streams of stress over a long period is labelled ‘Chronic Stress’ and each time one of these stressors pops up, cortisol is released by the adrenal glands, putting you into a Fight-or-Flight mode. This state is super beneficial for our bodies as it can literally save our lives, but we should only be here temporarily until the danger has passed and we can go back into a relaxed, Parasympathetic State (where you want to predominantly be!).
The reason being, female bodies cannot process our sex hormones and cortisol at the same time, so if you are constantly in a Fight-or-Flight mode, high cortisol will take precedence and suppress the body’s ability to release the hormones needed for ovulation and menstruation.
If you are suffering from HA, or any form of irregular/ absent period, download my free eBook here to learn more about this and my detailed top 10 protocols for recovering your T.O.M.
THE SCIENCY BIT...
It is important to know that HA looks different on every woman, and any woman can experience HA, regardless of their body size!
I have already mentioned the Hypothalamic being responsible for controlling the signals to stop the reproductive system. This part of the brain controls EVERYTHING to do with homeostasis – which means making sure the body is kept in a constant, stable position. It regulates body temperature, hunger and thirst, mood, sleep and sex drive. It also produces Gonadotropin-Releasing Hormone (GnRH) which starts a hormone cascade in the body by signalling to the pituitary gland to release Luteinizing Hormone (LH) and Follicle-Stimulating Hormone (FSH).
FSH – stimulates the growth of ovarian follicles to produce mature eggs ready for ovulation.
LH – signals the release of a mature egg from the ovaries during ovulation.
Following this, these two hormones then signal the ovaries to produce estrogen and progesterone. Estrogen is essentially your “growing” hormone as it prepares the uterus for pregnancy and matures the egg before ovulation. Progesterone, your “relaxing” hormone is key to balance the effects of estrogen by controlling the build-up of the uterine lining and maintaining a pregnancy. A balance of all of these hormones is required for menstruation.
Being the link between the endocrine system and the nervous system, the hypothalamus is sensitive to cortisol (your stress hormone). High levels of cortisol produced by daily environmental stressors, over-exercising or under-fuelling can signal to your brain that the body is not a ‘safe’ place to potentially create and nurture a new life, and consequently, GnRH levels decrease, which in turn, will reduce the number of other hormones produced (FSH, LH, estrogen and progesterone). When these levels are low, you may lose your period or have difficulty ovulating and getting pregnant.
THREE MAIN DRIVERS OF HYPOTHALAMIC AMENORRHEA:
We have already touched on the fact that under-eating, over-exercising and mental/emotional stress are the three main contributors to HA, so it seems the most logical way to reverse HA is to work on these three things and hence, the essential equation for getting your period back is:
Eat more + exercise less + tackle mental/emotional stress
And in turn, this will reduce the amount of STRESS on your body and bring you out of an energy deficit.
UNDER-EATING
Unfortunately in today’s world, our constant obsession with being in a calorie deficit and trying to shed some extra weight has left half the population massively underfed! As well as this, as a society, we tend to banish certain food groups from our diets because we’re jumping on the next heath FAD or diet trend seen online/in magazines. Hands up if you’ve seen or been told that eating 1,600 calories a day will be perfect to sustain you on your weight loss journey? Well did you know that your body requires AT LEAST 1,200 calories each day just for your basic bodily functions (e.g. keeping your heart beating, your lungs breathing, your brain working etc) and that’s before you even consider any type of movement!
Low-calorie diets are NOT sustainable, they are harmful to your body and they actually end up doing more damage than good!
Caloric deficits are not the only deficits that are seen in HA cases. Macronutrient deficits are a big one as well. Primarily we see women eating too low FAT or low CARB, OR BOTH (double whammy). This is a big no-no for reproductive function.
NEWS FLASH!! Eating carbs aren't bad for you, eating fat won't make you fat, sugar is not the devil, and eating past 6 pm doesn’t mean double the calories (like seriously?!). It’s ok to eat beige foods and to snack between mealtimes, and for crying out loud it's ok to eat bananas! There is NO such thing as ‘good’ or ‘bad’ foods. Food is food, and it all serves a purpose and, in your case, it’s going to be the thing that heals you and brings back your period.
I am going to highlight carbs and fats here as these are the two groups that are usually most demonized and restricted(protein is important too though!). Carbohydrates are essential as they are the main source of fuel for your body, your body doesn’t care if these come from bread, grains, potatoes or beans, but it needs carbohydrates(glucose)to work our muscles, organs and everyday functioning. If you restrict this fuel, it turns on the stress hormone in your body and signals the hypothalamus that your body is in starvation mode and consequently, this will continue to suppress reproduction.
Fats are also equally important as they balance energy levels, regulate appetite and produce those juicy sex hormones we need for a normal period. A diet that lacks adequate amounts of fat intake can result in pale skin, decreased energy levels, crazy mood swings, dry hair and... NO PERIOD. Unsaturated fats are the ones you want to be getting into your diet, so try adding things like peanut butter, avocado’s, seeds (flax, sesame, pumpkin, chia, hemp), green leafy veggies, salmon, nuts(walnuts, almonds, macadamias)& olives.
2. EXERCISE
Before getting my period back, I would workout 5-6 times a week high intensity and cardio, with a few yoga sessions thrown into the mix and long weekend walks. Maybe you’re thinking this doesn’t sound like a lot? For my body, this was too much. Although I felt as though working out gave me energy and helped with my anxiety, in reality, it was only depleting my energy levels even further and increasing stress on my already stressed-out system.
Every person is different and can handle a different amount or intensity of exercise and of course, it depends on whether you’ve been exercising too much IN RELATION to how much you’re eating. Activity increases your need for calories, so if you’ve been under eating calories in an effort to stay or get thin, then your body’s need for increased food hasn’t been met. That signals the starvation alarm in your body and sends cortisol through the roof – not to mention, the act of high intensive exercising in itself is a STRESSOR as it raises cortisol, so if you add workouts ON TOP OF an already stressed system, it’s a recipe for disaster.
3. MENTAL & EMOTIONAL STRESS
In today’s world, it is so easy to normalize the amount of stress we are under.
Women are amazing, and we are constantly juggling job pressures, family schedules, money issues, career and educational advancement and child and elder-care concerns to name a few... and on top of this, trying to prove to themself and others that they can ‘do it all’.
Data shows that 50% more women than men are stressed out, which means females are starting to feel the strain and this can show itself through anxiety, fatigue, depression and late/missing periods.
The truth is, we have to be INTENTIONAL about stress relief, setting boundaries, and balance in this world if we want to maintain a semblance of peace in this busy, comparison obsessed age.
TOP TIPS TO RECOVER YOUR PERIOD:
The good news is, FHA is completely reversible through lifestyle changes, and just like HA might look different on every woman, the recovery will also be different, along with the amount of time it takes you to get your period back.
Some of the best and most effective ways to do are:
EAT MORE
EAT MORE! For some of you, this might be double what you are currently eating. I know this seems scary, and yes, you are going to gain weight, but this is the best thing you can do for your body right now. If you have been in a chronic energy deficit, you will need to eat enough food to not only fuel your current energy needs but also make up for your past of under-fuelling.
It is recommended that you need to eat a minimum of 2,500 calories when you have HA, but some women need to be sitting more in the region of 3,000-4,000 calories, especially if you are still exercising (which I will touch on below). I recommend starting with at least 2,500 calories and give your body plenty of time of consistently eating this way to heal.
When it comes down to the questions of what you should be eating, think high calorie, nutrient-dense foods from all macronutrient groups (including carbs, fats and protein). Many women who struggle with amenorrhea have spent a period of time restricting at least one group of macronutrients. Cutting out a whole macronutrient group isn’t healthy for your body. It turns on the stress hormone and signals the hypothalamus to continue to suppress reproduction. For me, restricting like this made me feel even more stressed and a need to control, leaving me to have a pretty unhealthy relationship with food, and making me fear them even more.
Calories are SO important when it comes down to recovery! I am emphasising this again because if you are not getting enough calories, it doesn’t matter how much you focus on certain vitamins & nutrients, it’s not going to matter if your body still thinks you are in starvation mode. At first, as you add in more of certain macronutrients and increase your food intake, you might notice a change in your digestion. You will need to give your body a chance to re-adjust to eating new foods and more food, so a little bit of bloating is normal in the short-term.
Another way to make sure you are giving your body MORE than enough food is by regularly feeding it! So, forget about the strict 3 meals a day rule and start incorporating snacks every 2-3 hours, ESPECIALLY IF YOU ARE FEELING HUNGRY! This will keep the body in a fed state and it’s a sure way to make sure you are getting enough calories!
Eating frequently will also help with repairing your adrenal glands, by preventing blood sugar crashes, food cravings and stress on the HPA axis, but rather than snacking on fresh fruit or low-calorie energy bars, be sure to include nutrient-dense foods that cover all macronutrient groups!
2. EXERCISE LESS
The best and quickest way to recover from this is to stop training altogether. This will give you a chance to turn inwards and understand what works for your body, listen to how it feels and work with it, rather than against it. I understand that ditching ALL forms of exercise though can be tough to cope with, especially mentally, so I would recommend giving the high-intensity and cardio workouts a break and start incorporating gentle walks and restorative yoga into your day and you’ll be amazed at how different you feel, how much energy you suddenly have and how much happier and less stressed you are.
3. ADDRESS YOUR STRESSORS
Operating out of a sympathetic dominant state is not a healthy way to live, so addressing your life stressors and how you process and deal with them is pivotal to bring you back into a relaxed, Parasympathetic State, where you want to predominantly be!. The best way of coping with stress is to shift your internal being (if you haven’t already guessed it, changing your mindset is a big part of this).
My most practical stress hacks are:
Just taking some time to breathe. I'm talking about those juicy, deep belly breaths that help stop your racing heart and centre your mind. Intentionally changing your breathing patterns can help move you into a relaxed state, and the best part is, it can be done anywhere, anytime!
Turn off your phone. Unplugging yourself from that anxiety-driven cycle of checking your phone every minute will immediately reduce your stress levels.
Get outside in nature.
Try meditation. This is my absolute favourite and it worked wonders for my every-day wellbeing. Even just setting aside 5 minutes to get grounded and clear your head can shift your mindset. I switch between @headspace and @1giantmind (FREE!) so check out these apps if you're wanting to get started!
Do something you love. This sounds so simple, but having fun is the best type of stress relief; whether it's painting, reading, baking or simply taking a bubble bath, it’s the best medicine to spice up your life and stave off burnout. Also, on the plus side, you will probably have more time on your hands since lowering your exercise which means freeing up more time for things you love!
Affirmations and positive self-talk. Repeating affirmations can be powerful in reducing stress, as you are training yourself to focus on peaceful, positive aspects of life. Using post-it notes, writing in a journal or just saying them out loud helps set you up for a positive day and melt away tension. Some of my most used affirmations are ‘I am releasing all negative emotions from my system’, ‘I deserve a peaceful and loving life’, ‘I love myself for who I am’, and 'I am relaxed and calm’.
Journaling. Simply writing down your thoughts and feelings on a piece of paper can help you understand them more clearly and gain control of your emotions. If you want to up-level this even further, you can write down your negative thoughts and then re-write them with a positive thought to change the script in your mind.
Laugh. Nothing works faster to get your mind and body back into balance than laughter! It boosts your mood, diminishes pain, strengthens your immune system and protects you from stress, so laugh as much as you can!
Get your head below your heart. Getting upside down promotes blood flow to the brain and helps mellow the nervous system through a very clever feedback loop that turns off the fight-or-flight response.
Sleep. Stress and sleep have a two-way relationship, so following a regular sleep routine calms and restores the body and enables you to be better equipped for dealing with stress.
4. BE KIND TO YOURSELF
This might just be the most difficult protocol of all, but this is so so important. For me, at first, all I could think was, ‘there is no way I can do this! I've spent so long trying to lose weight and get my "dream body", and now I am going to throw it all away’. I suppose this is
why it initially took me over a year to fully commit to recovery because I just couldn’t let myself go. The reality is, you are going to have to gain some weight to get your period back. Some women only need to gain a few pounds, others more, but typically, if you have lost weight and lost your period, you might have to gain more than your original weight for your period to return, which I know can be hard to hear, let alone accept. But one thing I want to tell you is, trust in the process and be kind to yourself.
5. BE PATIENT
Last but not least, be patient with yourself. A lot of women make the mistake of trying everything they can to get their period back for a month or so, and if they don’t see results, they give up. Unfortunately, getting your period back this quickly is rarely the case, and if you have had amenorrhea for a long time, it can take a long time for your body to trust you again and heal. Data collected by Dr Nicola Rinaldi shows that the median time to recovery is six months, but the truth is, you will have absolutely no idea on how long it will take and where you will fall on this scale. The more dedicated and persistent you are with following these recovery protocols, the quicker your recovery time will be. HA is reversible, and you will get your period back. Put healing at the forefront of all of your decisions and relax into the process. Focussing obsessively on recovery won't work as this adds stress back into the equation and you right back into that fight-or-flight mode (which you’ve just learnt fantastic ways to keep out of).
I firmly believe that everything in life happens for a reason, and HA recovery was one of the best things that happened to me as it allowed me to reconnect to my body and woke me back up to what is important in life, pure happiness from the inside out.
If you are suffering from HA, or any form of irregular/ absent period, download my free eBook here to learn more about this and my detailed top 10 protocols for recovering your T.O.M.
Charlotte x