HA Recovery: Everything to Know About Hypothalamic Amenorrhea

Although sometimes inconvenient, menstrual cycles are vital for females’ health. Sometimes considered the sixth vital sign, the absence of a menstrual cycle can indicate serious health problems. 

Thanks to newer research, it’s much easier to gain a period back nowadays. Read on to discover everything you need to know about missing menses and HA recovery.

What Is Hypothalamic Amenorrhea?

Hypothalamic amenorrhea (HA) refers to losing a period for three or more months. Hypothalamic amenorrhea causes hormonal and metabolic problems along with a cascade of additional issues down the road. 

In HA, the hypothalamus, which connects the endocrine system to the brain, releases too little gonadotropin-releasing hormone (GnRH). GnRH signals the ovaries to produce estrogen and other reproductive hormones, so a lack of it halts menstruation and ovulation.

Beyond not being able to conceive, HA also causes women to prematurely experience menopausal symptoms like bone, skin, and hair problems. In addition, a lack of ovulation increases the risk for ovarian and uterine cancer.

What Causes HA?

Typically, HA is caused by restrictive eating habits (eating too few calories), overexercising, stress, genetics, or any combination of these factors. For this reason, females with eating disorders, elite athletes, and women experiencing large amounts of stress are most likely to suffer from this condition.

It is commonly believed that emaciated or very low body fat percentage females are the only ones to experience HA. However, it can happen to anyone of any body shape or size. 

Although the physical stress of undereating and/or overexercising most often causes HA, any female undergoing high mental stress can experience it as well. 

Thankfully, HA is recoverable!

Hypothalamic Amenorrhea Recovery

Though a progesterone-only birth control pill is typically prescribed for HA, this is really just a bandaid. It is prescribed to initiate the bleeding part of menses, but it does not induce ovulation. This causes the hormonal imbalances and metabolic issues mentioned above. Instead, gaining a period back involves treating the underlying root causes of stress whether it is mental or physical.

HA is often caused by glamorized societal factors, such as eating too few calories, intense exercising for multiple hours a day, and constantly remaining busy to the point of ample stress. So, it can be gravely difficult to break these habits.

Most recently referred to as ‘going all in’ HA recovery often requires a team of professionals including a dietitian, therapist, and doctor of some sort.

Get Your Period Back Meal Plan

The main objective of ‘going all in’ revolves around eating enough food. The most obvious culprit of HA, not eating enough sends signals to the body that it is unsafe for ovulation. 

Essentially, the body recognizes that women in this state are not healthy enough to harbor a growing baby. Thus, eating enough and oftentimes, more than enough is necessary to elicit the return of a period and ovulation.

Although calories are not the end-all-be-all, they are pretty important when it comes to HA recovery. Essentially, the body needs to relearn to trust it is receiving enough calories and has enough body fat to support minimal functions before it will induce a period. For many women, this equates to eating much more energy than previously. While there’s no hard guideline, anecdotal evidence suggests females need to eat 500 to 2000 more calories than their previous maintenance level to resurge menses.

These notions can be extremely scary to a female, especially ones with disordered eating and eating disorders. It is important to note that not every female with HA is purposely undereating. For some, mental stress reduces appetite so much that they inadvertently eat too little.

Nonetheless, the food treatment approach is the same. Beyond actually eating enough, it also involves ditching the diet mindset, letting go of food rules, and retraining the body to properly sense hunger and fullness cues.

Eating “junk” food or typically-labeled unhealthy foods like donuts, burgers, ice cream, and pizza will certainly get the job done. However, there are more healthful ways to accomplish HA recovery.

All three macros include calorically dense foods that double as nutritionally dense as well as less caloric versions. When recovering from HA, and when in doubt, add more fat to easily increase calories without much bulk. While healthy, eating too many fibrous foods like fruits and vegetables can be problematic when increasing calories. 

Also, keep in mind that it is typical to need double or triple the normal serving size of the following foods. There are also definitely other foods not included on this list but it is a great start!

Fats

  • Nuts and seeds
  • Nut butters
  • Avocado and oil
  • Olive oil
  • Dairy
  • Some sauces and condiments

Protein

  • Fatty fish
  • Red meat
  • Chicken thighs and legs (not chicken breast)
  • Whey powders
  • Pork rinds
  • Beef jerky

Carbohydrates

  • Rice, quinoa, cous cous
  • Whole wheat pastas
  • Whole wheat breads
  • Starchy veggies like potatoes and winter squash
  • Desserts and pastries (still in moderation as this can drive up inflammation)

In addition to the specific types of food, meal timing is also important. Generally speaking, a female trying to eat enough to regain a period needs to eat every two to three hours regardless of hunger or fullness. Interestingly, this repetitive pattern actually reminds the body to eventually understand proper cues once again. 

However, at the beginning of recovery, it is most important that the body feels safe and starts to trust that it will, indeed, be consistently fed enough.

Exercise While In Recovery

There is a time and place for “balls to the walls” exercise, but throughout HA recovery is not one of them!

Just like undereating is physical stress, overexercising is as well. Even if someone is eating enough, if they are exercising too much for the body to handle, it can cause HA. Sometimes these folks are emaciated or underweight, but females in the normal, overweight, or obese category can still experience HA regardless of body fat percentage.

All in all, very gentle exercise or no exercise at all is necessary for HA recovery. While no one should feel forced to continue exercising, the mental benefits still remain. Thus, if exercising, the safest workouts during recovery include:

  • Light walking
  • Yoga or light pilates
  • Stretching
  • Very light cycling
  • Recreational sports (usually not soccer, basketball, track, and field, or similar ones though)

It is recommended to take many rest days per week and focus on reducing all forms of stress during this time.

Mental and Emotional Recovery

Eating large amounts of calories can be more difficult than imagined. And oftentimes, the mental and emotional aspect of recovery is the hardest. 

Females are likely being asked to change lifestyle habits that are commonly praised. For some, it might also be necessary to make major life changes like quitting a job, leaving a relationship, or stopping a sport.

Not to worry, though, a team of professionals is ready and willing to help. In the meantime, initiate the recovery process via the following tips:

  • Find a fitting therapist
  • Join a support group
  • Journal and/or meditate
  • Pursue energy work (like reiki)
  • Use calming essential oils to relax
  • Engage in enjoyable activities
  • Maintain or make new relationships
  • Join a community group (book club, church, spirituality club, etc.)
  • Create boundaries in work, social and personal life
  • Only keep fitting clothes or purchase new, comfortable ones
  • Ditch the scale
  • Diversify social media feeds with positivity
  • Follow body positive, intuitive eating, ‘all in’ and other body activist accounts
  • Rest, rest, rest! And achieve 7-9 hours of quality sleep per night

The Bottom Line

Caused by undereating, overexercising, and/or severe mental and emotional stress, hypothalamic amenorrhea halts ovulation, leading to hormonal and metabolic problems. Not only does it prevent women from conceiving, but HA can also reduce bone density and increase the risk for ovarian and uterine cancer down the road. 

While it may seem like a gift to miss a few or more periods, it is not healthy – period.

Treatment often requires a life overhaul and always includes reducing underlying physical, mental, and emotional stress. Nearly always, having a support team, eating plenty more calories, substantially reducing exercise, and/or correcting the cause of mental stress are pertinent. 

Use the above eating, exercise, and stress reduction tips to safely regain your period!

Reference:

Seaborg E. Functional Hypothalamic Amenorrhea Treatment Guidelines. Endocrine News. Published June 2017. https://endocrinenews.endocrine.org/no-easy-answers-new-hypothalamic-amenorrhea-treatment-guidelines/.

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