Hypothalamic Amenorrhoea – When your periods go AWOL

Understanding and treating missing periods naturally.

Hypothalamic Amenorrhoea (HA) is a condition you may have been hearing about more frequently lately. Despite being a bit of a mouthful to pronounce, this condition is unfortunately more common than many women realise. In simple terms, HA occurs when your brain stops communicating properly with your reproductive system, causing your periods to go completely AWOL! Let’s explore this condition in depth to help you understand what’s happening in your body.

Understanding Primary vs Secondary Amenorrhoea

Before diving deeper, it’s important to understand the difference between primary and secondary amenorrhoea:

Primary amenorrhoea refers to when a young woman hasn’t started menstruating by age 16, despite having undergone other normal pubertal development.

Secondary amenorrhoea, which includes Hypothalamic Amenorrhoea, occurs when menstrual periods that were previously normal and regular stop for three or more consecutive months in a woman who was previously menstruating.

What is Hypothalamic Amenorrhoea?

Hypothalamic Amenorrhoea exclusively affects women, as it’s directly related to the female reproductive system. This condition is characterised by the absence of menstrual cycles for three months or longer, and in some serious cases, periods can disappear for years.

HA stems from disruptions in your hypothalamus function – a small but mighty structure located in your brain. The hypothalamus serves as the control centre for numerous vital bodily functions, including:

• Regulating body temperature
• Managing hunger and thirst signals
• Controlling blood pressure
• Governing your sleep-wake cycle
• Influencing sex drive
• Orchestrating hormone production and activity

When the hypothalamus senses that your body is under stress, it responds by reducing the production of gonadotropin-releasing hormone (GnRH), which subsequently affects the release of follicle-stimulating hormone (FSH) and luteinising hormone (LH) – both crucial for ovulation and menstruation.

What Causes Hypothalamic Amenorrhoea?

Several factors can trigger this protective response from your body:

• Nutritional deficiencies or inadequate caloric intake: Your body needs sufficient energy to maintain reproductive function
• Excessive exercise or overtraining: This can occur across many activities and sports, not limited to any particular field. Even regular fitness enthusiasts can experience HA if their exercise regimen is too intense relative to their individual needs and caloric intake
• Chronic or elevated stress levels: Both psychological and physical stress can disrupt hormonal balance
• Low body weight or rapid weight loss: Even if you’re not clinically underweight
• History of oral contraceptive use: Some women experience delayed return of menstruation after stopping the pill
• A combination of these factors: Often multiple stressors compound the effect

It’s important to note that susceptibility to HA varies significantly between individuals. Some women can maintain intensive exercise routines or experience temporary stress without losing their periods, while others are more sensitive to these factors. This is why comparing your diet and exercise regime to others isn’t a good idea – your body has its own unique thresholds and requirements.

Many women experiencing HA don’t fit any stereotype. Even moderate caloric restriction combined with regular exercise and everyday stress can be enough to trigger this condition in susceptible individuals.

Why Does My Body Stop Menstruating?

From an evolutionary perspective, your body has sophisticated mechanisms to protect you during times of perceived threat. When your brain detects signals of potential famine (insufficient calories), physical danger (excessive exercise), or emotional threat (chronic stress), it essentially puts reproduction on the backburner to conserve energy for survival.

Think of it as your body’s wisdom – if resources are scarce or conditions aren’t optimal, it’s not an ideal time to support a pregnancy. Your body prioritises vital functions over reproductive capabilities until conditions improve.

The intricate hormone cascade that regulates your menstrual cycle requires everything to be working in harmony. When disrupted, the delicate balance of oestrogen, progesterone, LH, and FSH becomes compromised, resulting in anovulation (lack of ovulation) and subsequently, no menstruation.

It’s important to note that while HA is a common cause of secondary amenorrhoea (periods stopping after they’ve been established), other conditions such as PCOS, thyroid disorders, and premature ovarian insufficiency can present similarly. This is why proper diagnosis through a healthcare provider is essential.

Signs and Symptoms of Hypothalamic Amenorrhoea

Beyond the obvious absence of menstruation, you might experience:

• Low energy levels and fatigue
• Mood changes, including anxiety or depression
• Disrupted sleep patterns
• Reduced sex drive
• Dry skin and brittle hair
• Cold intolerance (feeling cold frequently)
• Bone density concerns (if prolonged)
• Difficulty concentrating
• Digestive changes

Comprehensive Approach to Managing Hypothalamic Amenorrhoea

Restoring your menstrual cycle requires a holistic approach targeting the root causes. As a naturopath, I find that a balanced strategy incorporating lifestyle modifications, nutrition, targeted herbs, and supplements offers the most effective path to recovery.

Nourishing Nutrition for Hormone Health

• Increase caloric intake: Most women with HA need at least 2,000-2,500 calories daily, sometimes more depending on activity level and body composition
• Prioritise carbohydrates: Adequate carbohydrate intake is absolutely crucial for hypothalamic function and hormone production. Your brain relies heavily on glucose, and including plenty of complex carbohydrates is essential. Include foods like sweet potatoes, pumpkin, whole grains (freekeh, quinoa, buckwheat, rice), sourdough bread, legumes, and starchy vegetables to provide essential energy for hormone production
• Include quality protein: Aim for 1.2-1.8g per kg of body weight from varied sources like eggs, fish, legumes, and quality animal products
• Prioritise healthy fats: Your reproductive hormones are made from cholesterol and require adequate fat intake. Include avocados, olive oil, nuts, seeds, and fatty fish in your diet
• Don’t fear dietary fat: 30-40% of your calories should come from healthy fats to support hormone synthesis
• Support gut health: Consume fermented foods (yoghurt, kefir, sauerkraut) and prebiotic fibres to maintain the gut-hormone connection (Note: fermented foods may not be suitable for those with histamine intolerance)
• Important: Under no circumstances should you attempt a low or no-carb diet when dealing with HA – your body needs carbohydrates to signal reproductive safety

Supportive Lifestyle Practices

• Effective stress management: Practice daily meditation, journalling, or gentle breathwork
• Prioritise sleep quality: Aim for 7-9 hours of uninterrupted sleep in a cool, dark room
• Connect with nature: Forest bathing (shinrin-yoku) has been shown to reduce cortisol levels
• Sunlight exposure: 15-30 minutes of morning sunlight helps regulate circadian rhythms and vitamin D production, both crucial for hormone health
• Mindful breathing: Practice 4-7-8 breathing (inhale for 4, hold for 7, exhale for 8) several times daily to activate your parasympathetic nervous system
• Create boundaries: Learn to say no to excessive commitments that contribute to your stress load

Appropriate Exercise Modifications

During recovery from HA, it’s crucial to scale back high-intensity exercise until regular menstruation returns. Consider these gentler alternatives:

• Restorative yoga: Focus on yin or gentle hatha practices that activate the relaxation response
• Pilates: Build core strength without excessive cardio stress
• Mindful walking: Particularly in natural settings at a conversational pace
• Gentle swimming: Non-weight bearing and relaxing for the nervous system
• Mobility work: Maintain flexibility without taxing your adrenal system

Once your cycles have returned consistently for 3-6 months, you can gradually reintroduce more intensive exercise while carefully monitoring your menstrual health.

Herbs & Supplements for Hormonal Support

Herbal Allies:

• Adaptogenic herbs: Help balance the body’s stress response and support adrenal function
  • Withania (Ashwagandha): Helps reduce cortisol and supports thyroid function
  • Rhodiola rosea: Enhances stress resilience and energy without stimulation
  • Holy Basil (Tulsi): Balances stress hormones and supports metabolic health
• Nervous system supporters:
  • Chamomile: Gentle calming effect without sedation
  • Passionflower: Reduces anxiety and promotes restful sleep
  • Lemon balm: Uplifts mood while calming the nervous system

Targeted Supplements:

• Acetyl-L-carnitine: Supports LH production and egg quality
• Magnesium glycinate: Essential for over 300 enzymatic reactions, including hormonal pathways (300-450mg daily)
• Zinc: Critical for reproductive hormone function and thyroid health (15-30mg daily)
• Vitamin D3: Many women with HA have insufficient levels (2000-5000 IU daily, based on blood levels)
• B-complex vitamins: Support energy production and stress response
• Omega-3 fatty acids: Provide building blocks for hormone production (1-3g daily)

When to Seek Professional Support

Recovery from Hypothalamic Amenorrhoea typically takes 3-12 months, depending on the severity and duration of the condition. While some women see improvements within weeks of implementing these changes, others require more time and personalised support.

If you’re experiencing:

• Absence of periods for more than 3 months
• Symptoms that significantly impact your quality of life
• Concerns about fertility or bone health
• Difficulty implementing lifestyle changes alone

It’s time to seek professional guidance. As a naturopath specialising in women’s hormonal health, I can help identify the specific factors contributing to your HA and create a personalised recovery plan that addresses your unique needs.

Your Path to Hormonal Balance Starts Here

Hypothalamic Amenorrhoea is not just about getting your period back—it’s about restoring your body’s natural rhythms and creating sustainable health practices that support your hormonal wellbeing for life.

If your periods have disappeared or become irregular and you suspect Hypothalamic Amenorrhoea might be the cause, I invite you to book a consultation today. Together, we’ll investigate the root causes of your hormonal imbalance and develop a comprehensive plan to restore your menstrual health naturally.

Your body wants to heal—sometimes it just needs the right support to find its way back to balance.

 

References

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Gordon, C. M., Ackerman, K. E., Berga, S. L., Kaplan, J. R., Mastorakos, G., Misra, M., Murad, M. H., Santoro, N. F., & Warren, M. P. (2017). Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline. The Journal of clinical endocrinology and metabolism, 102(5), 1413–1439. https://doi.org/10.1210/jc.2017-00131

Meczekalski, B., Katulski, K., Czyzyk, A., Podfigurna-Stopa, A., & Maciejewska-Jeske, M. (2014). Functional hypothalamic amenorrhea and its influence on women’s health. Journal of endocrinological investigation, 37(11), 1049–1056. https://doi.org/10.1007/s40618-014-0169-3

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