Healing Hypothalamic Amenorrhea

I have a hypothalamic amenorrhea update for you and as I’m sure you’ve gathered from the post title, it’s good news. I got my period back!!!

Cue the confetti, girl dancing in the red dress emoji. Seriously, I was so happy the day it arrived. I was literally doing a happy dance in our foyer.

Healing Hypothalamic Amenorrhea

If you’re new to the blog or don’t know why the heck I’m talking about my period today, check out my previous posts here: Part 1: Dealing with Post Pill Amenorrhea Part 2: Amenorrhea Update Part 3: HA: Eat More, Exercise Less, Stress Less. Long story short, I have been without my menstrual cycle since September 2014 so getting it again was like winning the lottery! Okay, maybe not THAT exciting, but still pretty awesome.

I wanted to write a blog post immediately, but I waited because I didn’t want to speak too soon and jinx myself. As of this month I’ve had three cycles so I feel comfortable sharing, mainly for all the other women out there struggling with a similar issue. I want to give each of you a hug and talk to you personally, but this post will have to do. I want you to know that healing hypothalamic amenorrhea is possible! The journey may not be fun or easy, but it’s definitely possible.

I’ve talked my situation through with some of my close friends, my family and doctor(s) and we’ve all come to the same conclusion — there’s no way to determine exactly what caused my period to come back or even why it stopped.

My functional medicine doctor, Tressa Breindel, likes to describe it as a perfect storm and says it was probably a combo of things, specifically these three (she sent me this content in an email):

1. DNA — Having a genetic predisposition that sets the foundation for what sort of response to the environmental/life factors that manifested. Possible gene polymorphisms that could lead to abnormal hormonal regulation.

2. Stress — This could mean anything. We all have a limited amount of internal resources to deal with our physical and emotional energy demands. We can look at this like a pie. So even if these demands are “positive” in essence, if our pie pieces are taken up, then we may not have much energy left for incoming demands, and could easily feel overwhelmed by any new demands.

Chronic mood issues or illness can take up a significant amount of our energy demands, outside of external pressures and issues. When we are dealing with chronic internal emotional and physical dysregulation, we probably don’t have much left over when something else does come up, and can feel easily overwhelmed.

Also, if we are feeling depressed, anxious or ill, we are more likely to perceive external issues as threatening, exhausting and taxing. Whereas if we were feeling balanced, well and resourced, we may look forward to an external challenge.

The point being, is what stresses one person out is dependent on their perception, their internal and external health resources and their internal emotional and physical health status. What is bad or intolerable stress to one person, may elicit no reaction or be a welcome challenge to another -or to the same person at a different, more resourced period of their life.

Common stressors that may play a role in women’s fertility:

  • Excessive exercise, either quantity or intensity
  • Calorie and other macronutrient (fat, carbs, protein) restriction
  • Emotional stress — internally or externally generated
  • Environmental stressors — anything that triggers inflammation, infection, increased need for antioxidant or endocrine function. This would interact strongly with genetic/epigenetic precursors for ability to handle them
  • SAD — standard American diet. Or any diet poor in nutrients and/or variety

3. Exogenous Hormones — AKA Birth control. It has liberated women and gave us control of our bodies and the direction of our lives, but it also can have negative physical consequences for some depending on our genetic and environmental factors.

So there’s not a single cause for hypothalamic amenorrhea and someone with the exact same diagnoses or symptoms might have different precursors and may need a different treatment plan. That said, I’m happy to share my experience in hopes that it might help others.

If you’ve read my previous posts you’ll know that when I was first diagnosed with HA my doctor’s main recommendation was to eat more and exercise less. I reluctantly took his advice to heart, gained weight quickly and decided to give up after about 2-3 weeks. I went back to my regular exercise and healthy eating habits. It wasn’t until June 2016 that I actually decided to full give my body the nourishment it needed. See below for a list of the items I think contributed the most to healing my body from hypothalamic amenorrhea.

1. Acupuncture — This is one thing that I swear by and I feel certain that it helped with my healing. If I could afford weekly sessions I would have gone once a week, but with our budget I did bi-monthly sessions. There is a ton of research suggesting acupuncture is good for hormonal balance and for fertility so if you’re struggling with either I highly recommend finding a good acupuncturist in your area. If you’re in the Richmond area I highly recommend Tressa Breindel at Integrative Health Richmond and Keith Bell at Oriental Medicine Specialists.

2. Cutting Out Exercise — This was tough, especially since my workout schedule seemed moderate (3-4 days a week, 1 hour or less),  but I decided I had to give it a try. It was the one big thing I hadn’t tried and I figured it was worth a shot, especially since I heard it worked for others. I could have cut back slowly, but I wanted to go all-in rather than taking baby steps. At this point I was determined to get my period back and was willing to do whatever it took so I basically cut out all exercise besides normal daily activity. The first week or so was the hardest, but after a while it was really nice not worrying over when I was going to squeeze in a workout. I also had way less laundry and a little extra free time each day. Sometimes I was productive with this extra time and sometimes not so much. To be honest, about two months in with no exercise I was getting ready to toss in the towel, feeling as though the process wasn’t working and that’s when I got my first period!

3. Yoga — My only exercise throughout the healing process was yoga and walking. To make sure I didn’t stress out my body I stuck with restorative yoga classes. These classes helped me feel active, reduce stress, and be more mindful. I strongly recommend restorative yoga and meditation to anyone with HA.

4. No Diet Restrictions — I started to embrace the Intuitive Eating principles, stopping food journaling and gave up the diet mindset of good and bad foods. All foods are equal, some maybe be more nutritious than others but they’re all fair-game. If there’s one good thing that came from this experience it’s that I found the Intuitive Eating approach. Previous to being diagnosed with HA I had already added meat back into my diet after being pescatarian for six years, but I still ate a “clean” diet and avoided gluten (based on a doctor’s recommendation). There were times when I would feel guilty about eating too much or foods that weren’t “healthy.” When I went all-in with trying to heal myself I decided that I would take away all the restrictions and allow my body to eat whatever I was craving. So now if there’s something I really want to eat that has gluten in it, I’ll eat it.

5. Weight Gain — When diagnosed with HA I wasn’t underweight (which is why I didn’t want to believe the diagnoses). My BMI was 21, which is normal, but my doctor still thought gaining weight might help, hence the exercise less and eat more treatment plan. With this approach I have gained almost 20 pounds in four months. I thought that by eating healthy and working out regularly I was doing everything right, but apparently it wasn’t what my body needed. Gaining weight is hard. The number has never bothered me, it’s just a number. But not being able to wear my favorite clothes is sad. Luckily I have a great support system, including Isaac who has been my rock through all of this. Literally one day I was getting dressed to go out with friends and started feeling pretty awful about nothing in my closet fitting. I was crying in our bedroom when he offered to take me to the store to pick something new out. He’s a keeper. 🙂

6. Herbal Supplements — When I was first diagnosed I googled natural remedies for hypothalamic amenorrhea. I found a few supplements for balancing hormones and started taking them. About a year in I was fed up with spending a ton of money on the supplements and taking like 10 pills twice a day without knowing if they were actually working. There were a few months when I just stopped taking all the supplements. Once I started working with my functional medicine doctor she made me a blend of herbs based on my cycle so I have one blend to take for days 1-14 and another for days 14-28. I’m not 100% sure what all is in each blend, but it seems that they’ve been helpful. I highly recommend working with a professional to figure out what supplements you should be taking rather than doing what I did originally by just buying whatever I saw recommended online.

7. A Support System — Having a loving support system during this process has been so helpful. All my friends and family have been incredible. Listening to me talk about this for hours on end, reminding me I’m still beautiful even though I’ve gained weight, etc. I know it’s been hard on Isaac but he’s been strong, encouraging and positive throughout everything. I also found a few online communities through Facebook for women with HA and they’ve been amazing — giving me support when I needed it most and helping me feel less alone with this whole process.

Last but not least, here are a few books I recommend for others going through HA  — Intuitive Eating, Taking Charge of Your Fertility and No Period. Now What?.

I hope this post is helpful. I know when I was in the middle of healing, hearing from women on the other side always gave me hope so I trust this post will do the same for you! <3

2020 UPDATE: Just wanted to share that after getting my cycle back we became pregnant and had a beautiful baby girl. If you’re currently struggling with HA right now I’m sending hope, love and positive vibes your way!

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    72 comments
    1. Shawna
      August 6, 2021 AT 5:50 pm

      I do have a question. I recently got my cycles back from HA as well. I’ve had 2 and waiting on my third. How long were your cycles at first and how many did it take to get more regulated?

    2. Rachel
      March 14, 2021 AT 8:32 pm

      This post is very overdue, but I cannot express how thankful I am for you for posting about your journey. I dealt with post-IUD amenorrhea for a year when we were trying to conceive, and it was an extremely difficult and emotional experience. I stumbled upon this post from your “Ask Me Anything” questions last summer on instagram, and it was more helpful than the 100s of other blogs and podcasts I had read/listened to.. Your tips helped so much – particularly the one about how you were in the healthy weight range but your body need a little more. Your experience was so refreshing and similar to mine (contrary to the other posts) that I think it was the best advice I saw in trying to ovulate. I never got my period, but got pregnant instead. I cannot thank you enough for sharing your experience and helping me get through such a difficult time.

      1. Brittany Mullins
        March 15, 2021 AT 3:09 pm

        So glad you found this post helpful, Rachel! <3

    3. Fitness health forever
      December 17, 2020 AT 9:57 am

      This is really an impressive article about yoga. Thanks for sharing it.
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    4. Nicole
      June 18, 2019 AT 5:12 pm

      Hi! I just wanted to let you know even though this post is a bit old, it’s still one of the few things that pops up when searching for HA; and it helped me so much when I got my diagnosis. For years I was told I had PCOS even though I was very thin and had no acne or high male hormones on lab tests so I was prescribed birth control to “regulate.” Well I know now that’s just a withdrawal bleed. Anyway, 11 months ago I decided to get off the pill bc they kept discontinuing the ones I was taking, then I had to start taking a new pill each time, and it was making me feel crazy with all the new side effects each time. After I got off the pill no signs of any period. It had been nearly 6 years since I had a natural period so I was beginning to lose hope. I took all your advice – first I gained 8lbs (which was really hard from a purely superficial standpoint, but I was very slightly underweight), I read intuitive eating to make sure I was really listening to my body when hungry and honoring these signs, changed my workouts from 4 days a week of Barre3 (the harder, longer more cardio based workouts) to only 3 days and really listened to my body and took it easy while doing them, did acupuncture once a week and took Acetyl L-Carnitine twice a day. Within 2 months of doing these things I got my first natural period today. Thank you so much for posting about your journey and giving me hope. I also hope this comment can help anyone like me who is here because of the lack of resources on this topic.

      1. Mioschi Stewart
        January 22, 2022 AT 10:07 pm

        Nicole, Thank you and you along with this post has helped me. 🙂
        I actually have not been diagnosed, however I have been intermittent fasting for a while and loosing weight however often times not feeling too well. I revisited the benefits of it and read it may not be the healthiest for a female body. Longer story short, I researched that and came across this as being a possible side effect. I looked up symptoms and definitely do check off a few, (almost all except the loss of menstrual period) and so I figured I better stop now to prevent.
        I know you stated that you gained 8lbs may I ask what you started off weighing? I currently weigh 110 and am 5’4. I wonder if I too need to gain weight.
        Thank you in advance.

    5. Audrey Schlegel
      May 18, 2019 AT 4:23 am

      Hi I had a similar story to yours, 3 years off the pill and still no periods when I was trying to get pregnant. I just came across this post so I am a bit late.

      I never got my period back- I got pregnant directly instead! Wow!

      I realized however that while I thought I was doing everything correctly, I wasn’t. First, exercising 3-4 times/week for one hour doesn’t qualify as little, it qualifies as moderate to intensive, depending on what you do.

      Second, food journalling UNLESS you have a really big issue with loosing weight is a sign of orthorexia, which is a HUGE stress for your body. Congratulations on realizing what the issue was!

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