Lost Periods – Could It Be Hypothalamic Amenorrhoea?
Updated: Sep 17, 2020
I previously experienced two years with no menstrual period. Nope, I wasn’t pregnant, nope I did not have a diagnosis of PCOS or an additional endocrine disorder (although I had the relevant medical testing to rule this out), I had something called functional hypothalamic amenorrhoea (HA), which fundamentally presents in response to stressors on the body – examples of which we will explore further in this article.
I am thrilled to share that my period naturally returned just before Christmas 2018 and it was the best present ever.
Who’d have thought I’d be celebrating something typically viewed as such a nuisance for us women? Whilst the absence of periods may have some perceived benefits, If you aren’t getting a monthly period it’s a sign that your body’s reproductive system isn’t functioning optimally, and this can cause multiple risks to our health if not properly addressed and corrected.
The reason I haven’t titled this article ‘how I got my period back’, is because the x, y and z for me and how I tackled my absent periods may look different for you to get the same outcome – that’s not to dishearten you, but it would be wrong for me and for anyone you see online, to give you a ‘do this to get your period back protocol’ – A thorough consultation is required to discuss your medical history and identify the possible contributing factors at play. When it comes to our health, it is not ‘a one size fits all’ matter as we are completely bio-individual. There absolutely are things that can be done nonetheless, whether it be through medical intervention or nutrition and lifestyle-related to promote regulation of your cycle and get you back to feeling your best.
The firing of hormones:
The menstrual cycle is controlled by signals from an area in the brain called the hypothalamus (our master endocrine gland). The hypothalamus sends a signal to the anterior section of the pituitary gland to stimulate the release of hormones to target tissues in the body to ‘make stuff happen’ – in this instance, we’re talking about gonadotropin releasing hormone, LH and FSH which then act on the ovaries to further produce sex hormones (i.e. oestrogen and progesterone). If the hypothalamus detects a threat and there is disruption to this pathway (HPG axis) then problems can occur.
Hypothalamic amenorrhoea = hypo (low function) thalamic (thalamus brain region) amenorrhoea (absent period).
The implications of not getting your period
Well firstly the obvious – fertility is impacted. If we are not ovulating and having a successful cycle, the possibility of becoming pregnant is halted – so if you are at a stage in your life where you would like this, your period (or lack thereof) is something which needs to be addressed whether it be through diet/lifestyle changes to put the body in an optimal environment for recovery, or specialist fertility treatment (or both).
Secondly, sex hormones such as oestrogen work in synergy with the mineral calcium, promoting the activity of osteoblasts (cells that produce bone). Without adequate oestrogen levels, our risk for osteoporosis/osteopenia may increase.
Another point to bring attention to is the HPATG-Axis, short for the ‘hypothalamic-pituitary-adrenal/thyroid/gonadal axis’. Simply put, it’s the intertwining of the central nervous system and endocrine system, so essentially if hormone secretion from one gland becomes compromised, it’s not unusual to have a knock-on effect on another’s functioning which can really whack us out of balance, preventing us from feeling our best. So therefore, could a problem with the thyroid gland affect our periods? Indeed. Can adrenal stress affect our cycles? It can. It’s all linked.
Additional complications associated with an imbalance of hormones:
An imbalance of hormones can exert an array of symptoms across the body, such as:
Reduced cognition and memory
Low energy and sleep disturbances
Low mood – we have oestrogen and progesterone receptors in the brain which help aid the synthesis and activity of neurotransmitters
Changes in sex drive
Physical ailments such as the quality of our hair and skin
Characteristics of Hypothalamic Amenorrhoea are typically linked to:
A low body weight/bmi or body fat percentage (or one that is insufficient for YOU) – for example, one woman may function well with natural periods at a BMI of 20 and another may function much better at a BMI of 24. Similarly, one woman may function well at a body fat of 18% and still get her period, whilst another may require staying at 23% for optimal hormonal function. You may be thinking ‘I want to be the one who functions well at 18%, though’. But who is to say that a low numerical value = our ideal of beauty and health? When we are our healthiest we are our happiest, and when we are our happiest we shine our beauty! Do not let social media and the fashion/fitness bubble skew your perception; I promise you abs do not = health. We need adequate fat tissue for aiding the release of certain hormones and enzyme reactions.
Too much exercise and not enough fuel/inappropriate fuel – (if you have been restricting carbs or fats – likely, this is what you may need more of). If you’re hungry all the time and are particularly active, listen to your hunger cues – EAT! Do not let some online macro calculator dictate your appetite or decide what you should be eating. Our exercise ‘tolerance’ is also different for all of us and the level of activity your friend can handle hormonally, may be completely different for you – do not compare, listen to your own body.
Emotional stress – There is a misconception that HA is solely related to a low body weight/over activity. Whilst this is a critical component, any stressor, physical or emotional to the body (including poor sleep, even) can be enough to halt your period. This element was largely central around my personal experience.
An underlying medical condition – absent periods can be a sign of an underlying medical condition. Please always visit your GP as first line of care if you haven’t had a period for 3+ months so they can organise appropriate medical testing to rule out a potential medical condition i.e. PCOS/possible thyroid disorder which may be resulting in menstrual changes (and of course to rule out the chance of pregnancy!)
Coming off the oral contraceptive pill – For some women, this can be a reason for our cycles to temporarily dysregulate due to a sudden change in hormone levels. If your period has not returned after 3 executive cycles, I’d advise visiting your GP to again, rule out the above.
Further on emotional stress and how it affects periods:
Ask yourself if this is an area you may not quite have balanced yet? If an emotional trauma or something in your past or present is having a significant hold on you or causing persistent feeling of stress, this is something to address. Our body preferentially puts our stress hormones (i.e. cortisol) in a superior position to reproductive hormones at times of need (which acutely, is a good thing – cortisol is essential for survival). In a life-threatening situation (let’s say being chased by a tiger), your adrenals are going to secrete adrenaline to enable you to run bloody quick and get away so you can stay alive – in this stressed state, the LEAST of your body’s concerns is to create a safe, sufficient environment for a baby to be created. Consequently, the body diverts a lot of pregnenolone (the precursor to both sex and stress hormones) towards stress hormone production and away from sex hormone production.
This is a clever thing our body can do, until it becomes more chronic and prolonged stressors i.e. a persistent emotional trigger and/or limited energy availability via food restriction or expenditure of energy (compared to fuel intake) remains dominant.
What can I do about it?
As previously mentioned, it’s not a ‘one size fits all’ situation. Multiple things can influence why our period may be missing.
As identified, there is a complex interplay between other hormonal pathways, energy availability is key, and there are certain nutrients we need to act as ‘co-factors’, aiding our body to allow certain chemical pathways to work more efficiently. Our genetics have a role to play in this and also the functioning of our liver and digestive system. These elements can all be worked on to put the body in a great position for a well functioning hormonal pattern. I also want to reinforce to you the importance of managing stress – yup, a tough but absolutely crucial part.
One important question you must ask yourself is this:
Am I prepared to make changes to my current lifestyle? This may sound silly, but in order to get your period back, you cannot continue doing the same thing and expect to get a different result (if I remember correctly, that is the definition of madness!)
Something has to give.
Some final tips from me to you – I’ve been there, I get it:
This article is a means of giving you a rough idea of parts of the parcel you may want to think about and start getting comfortable with to make period progress.
Make peace with your situation. It’s upsetting and frustrating but blaming yourself or adding extra emotional stress just adds to the burden, so know that things CAN be fixed, it may just take a little work and time so hang in there!
Get support. Visit your GP/gynae as first port of call to discuss appropriate testing/advice for ruling out any underlying medical condition which may be a result of absent periods.
It’s highly likely you may need to change your exercise regime and nutrition choices – seek help from a qualified nutrition professional who is clued up on HA and can appropriately guide you in this area.
Re-evaluate your current lifestyle stressors and work out strategies in which to deal with them. Yoga and meditation were things I found helpful personally, but this will likely differ for all of us. When you’re constantly running from A-B, trying to keep up with the pace of everyday life, it can be really challenging slowing down and making time for yourself, but you must make the time – your period is a very important indicator of health.
I hope you found this useful. I have every faith you can get through the other side like I did too. Be kind to yourself and take each day as it comes ♥
Research and further reading recommendations: