What is Hypothalamic Amenorrhea (HA)?
In this post I explain what Hypothalamic Amenorrhea is, what the symptoms are and how to recover from it. In the sister post What is Hypothalamic Amenorrhea (HA)? - The Science Behind I go more into detail of the science.
What is Hypothalamic Amenorrhea?
Hypothalamic Amenorrhea (HA), sometimes referred to as Functional Hypothalamic Amenorrhea (FHA) or Female Athlete Triad, is when a female loses her period due to stress. The stress can come in different forms:
under-eating, intentionally or unintentionally - which leads to something called low energy availability or relative energy deficiency
other stress (work stress, relationship stress, ...,)
Usually, Hypothalamic Amenorrhea is induced by a combination of all the above. Because of these stress factors, your body, or more specific your Hypothalamus (hence Hypothalamic Amenorrhea), which can be described as the body's control center located in your brain, detects danger, famine, threat, and as a result decides it is currently not safe for your body to become pregnant. Instead, it needs to focus its scare resources on activities essential for survival: breathing, supporting brain with energy, pumping blood. All other "nice-to-have", or non-essential functions like keeping your fingers warm or reproduction are shut down until your hypothalamus detects safety and better times again.
You can think of it as when your phone is low in battery and enters power saving mode. You can still use the phone and it is still working, but you can only use the most critical functions. Only when you manage to find a charger, you get access to the full spectrum and capacity of your phone again. Now think of your body. When the energy availability is low, your body is entering ‘survival mode’ to preserve energy. Just as with the power saving mode of your phone, the survival mode of your body - HA - is a reversible condition. When you are fueling your body properly again, it will ramp up all shut down functions and return to its full potential again.
Your body is not broken. Rather the opposite actually. Your body is acting very clever to keep you safe. Throughout evolution, this triad system has kept us alive during times of famine. Reproduction is an energy-intensive process, so it makes sense to ‘turn off’ this function during periods of energy scarcity.
How do the symptoms of Hypothalamic Amenorrhea look?
The first and most obvious symptom is obvious: a lack of period. There are however many other signs and symptoms common in Hypothalamic Amenorrhea. You might experience none, few or all of these symptoms:
Feeling constantly cold
Having a low libido
Being fatigued and feel exhausted
Waking up hungry in the middle of the night or early morning
Low levels of reproductive hormones, especially Luteinising Hormone (LH), Estrogen and Follicle-Stimulating hormone (FSH)
Thin uterine lining
Polycystic-appearing ovaries (many smaller follicles present on the ovaries)
Low bone density, osteopenia or osteoporosis
Brittle hair or hair loss
Low body weight or weight loss (disclaimer, HA occurs in women of all body sizes!)
Low body fat percentage (disclaimer, HA occurs in women of all body sizes!)
Restrictive eating behaviors
Compulsive exercise habits
High daily stress levels
How is Hypothalamic Amenorrhea diagnosed?
How Hypothalamic Amenorrhea is diagnosed tends to vary between countries and practitioners. But usually HA is a diagnosis of exclusion (similar to IBS). The absent of a menstrual cycle can have a lot of reasons, so your doctor will run tests to rule out other underlying deceases or conditions. In my experience, Hypothalamic Amenorrhea can be quite easily self-diagnosed by looking at lifestyle factors. Are you having restricting eating habits? Are you exercising (compulsively)? Are you under a lot of stress? If you tick these boxes (and have had a period in the past) then you can be quite certain you have Hypothalamic Amenorrhea. Low body weight or weight loss might be a factor, but it’s absolutely not essential for a diagnosis – Hypothalamic Amenorrhea can occur in women of all body sizes! If you’re concerned, it’s always a good idea to speak to a health professional to get everything checked. It is not uncommon that healthcare professionals misdiagnose Hypothalamic Amenorrhea. Up until resent years it was a fairly unknown condition. Here are some things to keep in mind in your contact with the healthcare system:
The most common misdiagnosis I see, is that doctors diagnose Hypothalamic Amenorrhea as PCOS - something that can have quite fatal consequences for recovery since the advises given in PCOS are quite the opposite of what is needed to recover from Hypothalamic Amenorrhea. I have a post on PCOS vs Hypothalamic Amenorrhea that you can read HERE.
Another common pitfall is that your doctor wants to put you on the pill to "fix" your period. He or she might say "come back (for fertility treatment) once you want to become pregnant" or "it is normal to not have a period if you exercise a lot". This is bullshit! A regular menstrual cycle is an indicator of good health, and the artificial withdraw bleeding caused by the pill is not a real period! So the pill-approach is really counterproductive, it will only mask your real underlying problem - the HA.
If you have the feeling your health care provider is not listening to you, try to see if there is someone else you can reach out to, you deserve to be taken seriously! Feel free to use this or any other of my posts in your discussion with your healthcare contact:
How do I recover from Hypothalamic Amenorrhea?
To recover from HA is simple but not easy. What you need to do is to reverse the state of danger that your body is sensing. This involves changing your eating and exercise routines:
eat more. You can read more about food and nutrition in these blog posts: How Much Should I Eat During Hypothalamic Amenorrhea Recovery? When Should I Eat During Hypothalamic Amenorrhea Recovery? What Should I Eat During Hypothalamic Amenorrhea Recovery?
exercise less - you need to reevaluate duration, intensity and frequency (read my post How Much Can I Exercise During Hypothalamic Amenorrhea Recovery? for details)
reduce other stress factors
Will I ever recover? How much weight do I have to gain? How long will it take? What if it does not work? I know how overwhelming recovery can be, but you don't have to go through Hypothalamic Amenorrhea Recovery alone. Feel free to reach out to me for guidance and support.