What's Hypothalamic Amenorrhea?

In the world of hormone health, periods play a critical role in identifying markers of health – is a period really long and painful? Is it heavy, or lighter than usual? And so on, and so forth…

When we look at hormones from an eating disorder-informed lens, periods now act as a marker of weight restoration and adequate nutrition. From this perspective, discussion shifts into the treatment and prevention of hypothalamic amenorrhea (HA).

What is HA? It is a condition where periods stop for several months, due to a change in hormone stimulation and regulation in the hypothalamus of the brain. It commonly occurs in menstruating people struggling with eating disorders but can also occur in those who are not. When the body does not receive adequate nutrition, is subject to excessive and harmful levels of exercise, or is experiencing significant amounts of stress, the body shifts into “survival mode” – this typically involves the down-regulation of hormones involved in menstruation as periods and pregnancy are non-essential functions for human survival. A human body can survive (and thrive!) without a pregnancy – it can also function without a period as many folks undergoing treatment for endometriosis, adenomyosis and some other conditions may “pause” periods in order to protect their health. However, if a period “goes missing” related to other factors, we see this as unsupportive of health.

Other tests are often done to determine if there are other reasons for a period to be absent – whether this is structural, related to other hormone imbalances, or related to a pregnancy! After ruling out other conditions, HA is typically diagnosed, often by a specialist physician in endocrinology.

So how is HA treated? It requires a whole-person, big picture approach provided by a comprehensive and collaborative health care team. All aspects of a person need to be considered when it comes to period health as no factor is typically the sole contributor to HA.

From a nutrition standpoint, it’s essential that the person receive adequate and appropriate nourishment. If there has been a significant amount of food restriction (for the purposes of intentional weight loss, throughout the course of an eating disorder or related to other illnesses), a dietitian can support individuals in addressing the increase of food intake to meet their energy and nutrient requirements. Often there is a need to loosen restrictions around fats and carbohydrates as these are commonly restricted and also provide a powerful source of energy for the body. By increasing nutrient and energy availability for the body, there is typically weight restoration that occurs in order to promote hormone production and cycling that supports a normal and healthy period.

The reduction, or even cessation, of exercise can also be supportive to HA treatment – if the body engages in significant amounts of exercise, energy is no longer available to the tissues for recovery and rebuilding. This area often requires a combination approach as stopping exercise can bring up lots of feelings of guilt and shame – in today’s society we are taught to aspire to lots of activity and encourage productivity over rest (even though rest can be significantly productive to health). A counselor, physical therapist and dietitian can be helpful to develop a healthy relationship with activity, fuelling for movement and avoiding or treating injuries caused by excess exercise.

Other stressors also need to be addressed, often through a skilled therapist or psychologist. Situations such as trauma, grief and others can contribute to high levels of cortisol (the stress hormone) and further prevent normal cycling of menstrual hormones. These providers can assist individuals in developing new coping skills, accessing resources in their communities and providing a safe space to process life-altering events.

If you think you may be struggling with HA, or have concerns about period health, it’s important to get help and you are worthy of recovery. To learn more about how nutrition and lifestyle factors can impact your period wellness, you can reach out directly to [email protected] - I work with individuals to promote period health and support their best wellness, at all sizes!