Getting Your Period Back After Hypothalamic Amenorrhea

For the first few months of not having my period, I kind of loved it. At age 17, I wasn’t concerned with the long term implications of losing my menstrual cycle and the negative effects it could have on my health. At the time, I welcomed the break from severe cramps 7 days a month, uncomfortable bloating, and carrying around wads of tampons in my purse. It wasn’t until I began seeing a doctor for my anorexia (more on this here) that I realized this was actually a pretty serious issue. Before I dive into how I regained my period, let’s talk more about what Hypothalamic Amenorrhea is, why it occurs, and when to be concerned. 

Hypothalamic Amenorrhea (HA) is the absence of a menstrual cycle for at least several months. This condition involves the hypothalamus, which is a gland in the brain that releases the gonadotropin-releasing hormone (GnRh). GnRh stimulates the pituitary gland to secrete luteinizing hormone (LH) and follicle-stimulating hormone (FSH). LH and FSH cause the ovary to release estrogen and progesterone, which are hormones involved with menstruation and reproduction. So without GnRh, there is no LH or FSH. No LH or FSH means no period. No reproduction. 

HA is most commonly found in individuals who are of low body weight, have low body fat, consume very few calories, are under severe emotional distress, and/or participate in intense strenuous exercise. HA can also be due to a completely separate medical condition, so if you’re experiencing it, it’s important that you talk with your physician about it prior to self-treating. In my case, HA was predominantly due to my overall low body weight, low body fat percentage, and extremely low energy intake. At the time I was experiencing HA, my resting metabolic rate was around 1,500 calories/day. Resting metabolic rate refers to the number of calories a person needs to consume each day to perform regular activities of living, not counting deliberate exercise. On top of this, I was burning approximately 500 calories per day through exercise, meaning I needed to consume around 2,000 calories per day to maintain my weight. While I was battling anorexia, I was consuming just 1,200 calories, putting me at a daily deficit of 800 calories per day. I was rapidly (an unnecessarily)  losing around 2 pounds per week. A sure cause of HA. Our bodies are smart enough to know when something isn’t quite right. Because my body was struggling to just keep me alive, it knew it was in no condition to be growing new life inside of it. Therefore, my reproductive organs closed up shop. Shut down until further notice (aka until I got my act together and started treating my body right). 

After I began receiving treatment for my eating disorder, I was educated on the importance of a regular menstrual cycle. My doctor informed me that long term HA dramatically decreases a women’s chance of being able to reproduce later in life. It also increased my chances of developing osteoporosis, stress fractures, emotional distress, heart disease, and low libido. The thought of not being able to bear children someday gave me the motivation I needed to regain my cycle. That, and the fact that I was ready to regain food freedom and kick anorexia to the curb anyway. And thus, began my road to recovery with a major goal being to menstruate on my own once again. 

It took years, but after gaining a reasonable amount of weight and nourishing my body appropriately, my period returned. I was lying on the couch watching TV with my mom one evening when I felt a slight cramp in my lower abdomen. Menstrual cramping was a feeling I hadn’t experienced in years, but I recognized it immediately. A feeling I used to despise was now giving me a glimmer of hope. A few hours later while using the restroom, my period finally made it’s second debut. She was back, and I welcomed her with squeals of joy and even a few tears. I had reached my goal and my body was thanking me. For the first time in 3 years I felt loved by my own body. For years up until that point, the skin I was living in felt foreign. It felt as though I were at war with my body. Reaching my goal of menstruating on my own felt like a major victory and it gave me motivation to continue recovering all the way to weight restoration (a goal that, at the time, I was still striving towards). 

I feel the need to clarify that, although I have been menstruating on my own for over 6 years now, I don’t know the long term effects that HA may have had on my body. My husband and I, at the time of writing this article, have not attempted to conceive. It is still unclear whether or not my long term HA will have a negative effect on my reproductive system or if we will struggle to get pregnant when we begin trying. I fight a negative voice in my head that tells me I’ve screwed up my future because I suffered from an eating disorder. This voice tells me lies about how I will never be a mother and it’s all my fault. I know these thoughts are not from a pure or good place. These thoughts are from the enemy and are meant to destroy. These thoughts are useless and most likely not true. I refuse to let fear creep into my life and cause anguish and suffering. I find peace in the fact that I am loving my body and treating it with respect. Everything is my life has lead me to this point. All of my experiences, both good and bad, have made me who I am today. And for that, I am eternally grateful. 

If you or someone you know is struggling with HA, I encourage you to reach out first and foremost to your physician. In addition, a Registered Dietitian like myself would love to help you find the right nourishment that your body needs to restore healthy hormone levels for mensuration. Your body is unique and it’s important that we treat it as such. 

If you’re interested in finding food freedom and ditching diet culture forever, check out my 10-week, self-paced, online intuitive eating course by clicking here.