86. Hypothalamic Amenorrhea: How Over-Exercising and Under-Eating Can Stop Your Period

What happens when your period disappears, and you're not pregnant or in menopause? Many women don’t realize that a missing cycle is a critical health signal, not just an inconvenience. In this episode, Dr. Monica Minjeur unpacks Hypothalamic Amenorrhea (HA)—a condition where stress, intense exercise, and inadequate nutrition cause the brain to halt ovulation. You'll hear Maggie’s journey of losing her period for two years, how she restored it naturally, and why fixing HA is essential for fertility, bone health, and overall well-being. If you’ve ever been told that losing your period is “normal” for active women, this episode is a must-listen!

Transcript

Monica: 0:02

Welcome back to Cycle Wisdom, where we empower women to restore natural menstrual cycles, to improve health and promote fertility. I'm your host, Dr. Monica Minjeur, and I'm so glad you're listening today. What happens when your period just disappears? You're not pregnant, you're not in menopause, and yet, month after month, nothing happens. Many women feel lost when their cycles stop not realizing that their body is trying to tell them something important. Today we're going to dive into a condition called hypothalamic amenorrhea. We're going to discuss what it is, what causes it, and most importantly, how to restore your natural cycle. Let's get started with Maggie's story. Maggie came to see me as a 25-year-old. She was a marathon runner and a fitness enthusiast. She followed a fairly strict clean eating regimen, tracked every calorie and trained intensely for hours every week. Her lifestyle seemed ideal. Her lab levels for her cholesterol and blood sugar were impeccable, and everything seemed to be going well with her health until her period disappeared. At first, Maggie didn't think much of it. Many of her other running friends had irregular cycles, and other doctors had reassured her that it was normal for active women to stop having a cycle. Her obstetrician actually suggested birth control in order to try and bring her cycle back, but Maggie wasn't interested in that. She did want to fix the underlying problem, but also didn't want to change her current lifestyle. By the time she came to see me, Maggie had not had a period for the last two years. What changed for her is that she had recently gotten engaged and she was eager to start a family after they got married. However, she knew that without having a regular cycle, she would likely not be able to get pregnant. During her first visit with me, I asked Maggie detailed questions about her diet, her exercise habits, her stress levels, and her health history. I found out that she ate very few carbohydrates. She prioritized lean proteins and vegetables and minimized the amount of fat she had in her diet. She exercised fairly intensely six days out of the week, oftentimes running long distances and doing high intensity interval training workouts. She had a history of stress and perfectionism, always pushing her limits, but always succeeding at just about everything she put her mind to. Her body mass index was a little bit low, but it was still considered within the normal range, and so many of her other doctors overlooked nutrition as a factor, thinking she's very healthy, she's eating well, she's exercising regularly, and so she shouldn't be having any troubles. From that first visit. I ordered some lab work and her hormone testing revealed that she had very low estrogen and progesterone levels. In fact, her levels were so low that they were seemingly. Aiming towards menopausal levels, even though she wasn't even 25 years old yet. Okay. She also had low LH Luteinizing hormone and FSH follicle stimulating hormone, confirming that her brain was not sending a signal to her ovaries properly in order to make sure that she was ovulating. She also had slightly decreased thyroid function, which is a common side effect of not getting enough calories. Based on her clinical picture as well as the lab testing, I was able to diagnose hypothalamic amenorrhea. I let her know that missing her period was not just a coincidence. It was her body's way of trying to conserve energy because it thought she was in survival mode. Now treatment of hypothalamic a amenorrhea can be very challenging. And so I worked together with Maggie to create a step-by-step protocol to help recover ovulation and restore her fertility naturally. Step one was working towards increasing her caloric intake, and we'll talk about what that looks like a lit little later in the episode. Okay. Step two. We worked to reduce her high intensity exercise. Now, I didn't make her stop exercising altogether, and this was mentally really challenging for her. But Maggie learned that rest was a key part of healing her cycles. We talked through stress reduction, optimizing her sleep, and also started her on some hormonal and nutrient support with supplements and prescription strength medications. For the first couple of months, Maggie struggled a lot mentally and physically. She felt like she was losing control because we were telling her she needed to eat more. She had to cut back on exercise. But after four months of dedicated recovery, Maggie had her first natural period come back after two years without a cycle at all. She also noted that her energy levels had significantly improved. She had fewer mood swings and her lab tests showed increasing hormone levels and improvement on the ovulation tests. Today, Maggie continues to support her hormones through making sure that she's getting adequate amount of nutrients, balancing her exercise and mindful stress management. She's looking forward to getting married and hopefully being able to conceive naturally without needing to use fertility drugs or IVF Now that her cycles are back on track. Maggie's story is so important because it's not just about missing periods, it's about your body giving you a signal that there's an energy imbalance. Fixing that imbalance requires more than just birth control. It requires true healing. So what is hypothalamic amenorrhea? Maybe you've never heard of this, maybe you know what it is, but you didn't realize that was the medical term for it. So hypothalamic amenorrhea is a condition where the hypothalamus stop sending signals to the ovaries leading to a loss of menstrual cycles. Now your hypothalamus is in your brain, and think of it as the brain's hormone control center. So this isn't a problem with your ovaries or your uterus, it's a response to stress, which can be physical, emotional, or nutritional. Most commonly we find this, if there is not enough energy available for your body to meet its daily needs. So this can come on if you're not getting enough caloric intake, if you are excessively exercising, especially with high intensity workouts, if you have psychological stress. So even just that mental or emotional strain can disrupt the hormone balance. Or if you have rapid weight loss or low body fat, even if your weight is considered to be in a normal range based on BMI, that significant change or a rapid drop can make your period stop happening for a time being. So why does this matter? Lots of women say, I don't care. I don't even want my period. I don't need it. It's annoying. I'm not trying to get pregnant right now. But hypothalamic amenorrhea is more than just missing a period. It's a red flag. It's your body's way of saying. This is not okay. I don't have enough energy to balance all of the needs that are going on in my body, and if left untreated, hypothalamic amenorrhea can lead to serious long-term health consequences that can impact fertility, bone health, heart functioning, and your overall wellbeing. So let's break that down a little bit. The first area of problem can be infertility and reproductive health issues. Now what we find in these cases is that hypothalamic a amenorrhea is caused by a decrease in gonadotropin releasing hormone. This is what leads the body to fail to properly signal ovulation, resulting in anovulation, so not ovulating, which makes pregnancy naturally impossible. You aren't gonna see regular cycles happen with this. We oftentimes will see low progesterone levels, which also increases the risk of early miscarriage. And if you're not having a regular cycle, if you're not ovulating, it's going to be incredibly difficult to conceive. So even if pregnancy isn't your immediate goal, not having your cycles can be a sign of hormone dysfunction that needs to be addressed. Another big area that I oftentimes see and we treat frequently in our practice is osteoporosis and increased fracture risk. Now you might be saying to me, wait a second, isn't osteoporosis just for women after menopause? The reality is, is that estrogen plays a crucial role in maintaining your bone density. And so when you stop having periods, when you have hypothalamic amenorrhea and your estrogen levels drop, your bones can become weak and brittle. This can increase the risk of osteopenia, which is early stage bone loss or kind of softening of the bones. You can also see osteoporosis, which is severe bone loss leading to spontaneous fractures. And for people, especially those who are athletes who have a low body weight, we see a significant increase in the risk of stress fractures. Women with hypothalamic a amenorrhea oftentimes show bone density loss equivalent to postmenopausal women, even if these women are only in their twenties or thirties. If left untreated, this bone loss may not be fully reversible, even if your cycles eventually return. And this is why it is so crucial to make sure that we are having the regular cycles so that we don't develop these long-term problems, which can be irreversible. Not having your cycles can also lead to an increased risk of cardiovascular disease. Again, estrogen plays a role here and estrogen is protective for heart health. If your estrogen levels are too low, it can lead to higher cholesterol levels. It can lead to blood vessel dysfunction and increased risk of heart disease and stroke later in life. Even young women in their twenties can have early markers of cardiovascular dysfunction if they have gone for some time without having cycles hypothalamic. A amenorrhea also oftentimes coexists with metabolic or thyroid imbalances. Your body is trying to reserve energy, and so it will downregulate non-essential functions. This can lead to a decrease in your metabolism, decrease in your thyroid function, which can then cause cold intolerance, fatigue, brain fog, constipation, depression. It can also cause insulin resistance, which increases your long-term risk of diabetes and metabolic disorders. And last but definitely not least. Not having regular cycles can have significant mental health impacts. Hormones play a huge role in your mood regulation, and women with hypothalamic amenorrhea frequently experience depression and anxiety due to low estrogen and the disruption of a neurotransmitter balance. It also can lead to an increased stress response and higher cortisol levels, which in turn make it harder to relax and recover. And finally, it can also cause brain fog and cognitive difficulties if you don't have enough energy in order to be able to keep things functioning. Women with hypothalamic a amenorrhea are typically found to have higher rates of anxiety and depression, even compared to women with other menstrual irregularities. So ignoring this does not just impact your fertility. It impacts every single system in your body. And restoring ovulation through nutrition, lifestyle changes and hormone support is critical for long-term health and wellbeing. I wanna include just a couple brief points here of what hypothalamic amenorrhea is not. Now, many women with hypothalamic a amenorrhea are mistakenly diagnosed with PCOS because both can present with missing periods, but the hormone profiles and the underlying causes are vastly different. So it's important to know what it is that you're dealing with. Losing your cycle due to over training is a sign of hormonal dysfunction, not peak health. So oftentimes women will think, I'm in great shape, my health is great. This is a great sign of fitness to lose your cycle, and that is not the case. And finally hypothalamic. A amenorrhea is not just about weight. Women of all sizes can experience this if they're under fueling or over exercising. So just being able to say, Hey, my weight is normal, or Maybe I'm still overweight. You can still have hypothalamic a amenorrhea regardless of what the scale tells you your current weight is. So how do we recover from this? How can you help restore your cycles again? Now again, as was the case with Maggie recovering from, this takes time patient and a multifaceted approach. And the key is really reversing the underlying causes. So addressing the energy deficiency, addressing stress and treating hormone balances. This will all help the body to feel in a safe space, safe enough to restore ovulation and menstrual cycles. So step one. Increasing caloric intake. No more undereating. This is the most common cause of hypothalamic a amenorrhea when you are not eating enough calories to support normal hormone production. Now, we typically will help women to calculate how many calories per day they need to be having, and generally there's gonna be two different numbers. One, if you're at rest and one number, if you're active, and for many women, you need to get upwards of 2200 to 2,500 calories per day. We also need to make sure that we're focusing on nutrient dense foods, including healthy fats like avocado, olive oil, nuts, fatty fish. To support hormone production, we need to make sure we have high quality protein to help rebuild muscle and metabolic function, as well as complex carbohydrates. Think things like sweet potatoes, oatmeal, rice, fruit, again, needing to fuel the body and replenish glycogen stores. Many women that are recovering from hypothalamic amenorrhea are afraid to eat enough, but reversing the energy deficit is non-negotiable. We will not get your cycles back on track if you don't have enough energy. Step two is reducing excessive exercise, especially those high intensity workouts. So as was the case with Maggie, she was really concerned she didn't want to stop exercising altogether. So instead, we encouraged her to reduce her high intensity exercise. No more long distance running. Limit the high intensity exercise, the CrossFit, the kickboxing, and really instead prioritize on low impact movements. Walking, yoga, Pilates, stretching. Strength training is okay, but not excessively Focusing just on moderate weight lifting with adequate recovery time. Many women with hypothalamic amenorrhea need to take a break from intense exercise for at least a few months in order to allow their cycles to return, and then addressing stress and cortisol overload. Now, we've talked a lot in other episodes as far as improving sleep, practicing relaxation, and reducing your mental stressors, but this is so incredibly important when it comes to how do we get your cycles back on track is managing the stress and managing the cortisol overload. Okay. From a standpoint of what do we do to help support everything else from a supplement standpoint, oftentimes we're making sure that we have appropriate amounts of good quality fats, iron vitamins, nutrients in your diet. Focusing on a high quality prenatal vitamin oftentimes is a great option to cover many of the bases. And then in some cases, we utilize bioidentical, progesterone and or estrogen therapy to help support cycles while the body is recovering. Oftentimes, we utilize this if your cycles still haven't returned after addressing diet, exercise, stress. If you're trying to conceive, oftentimes luteal phase support is needed. So addressing those hormones specifically after ovulation, and again, just treating with hormones, this alone is not a fix. It needs to be combined with lifestyle changes in order to restore that natural cycle function. Recovery does not happen overnight. It can sometimes take three, six, or even 12 months for cycles to return, depending upon how long the body has been in energy deficit. I. The key takeaway here for recovery is convincing your body that it's no longer in crisis mode. It's no longer just trying to survive. We need to make sure that you're eating enough, resting enough, reducing your stress, and supporting your hormone balance in order for your cycle to return. And this takes time. It takes working with a healthcare professional who understands this and who can be compassionate about working with you through this process. If you've been missing your period for more than three months and you suspect hypothalamic amenorrhea, it's important to take action and while you can change your lifestyle, and oftentimes women are able to get their cycles back on track, some cases may require additional medical support. So please reach out to for help if you've increased your caloric intake, reduced your exercise, but your cycle still hasn't returned after six months. If you're experiencing severe fatigue, hair loss, bone pain, or even if you've had a stress fracture, this can be a sign of prolonged hormonal imbalance. If you're struggling with infertility, needing guidance on restoring ovulation, or you want personalized lab testing to assess your hormone levels, nutrient deficiencies, and metabolic function, that's also a great time to reach out. If you've been struggling with missing your periods, feeling exhausted or facing fertility challenges because of hypothalamic a amenorrhea, please know this. You are not alone, and this is not your fault. Your body isn't broken. It's just asking for help. You deserve to feel strong, to have balanced hormones and to trust your body again. Healing from hypothalamic amenorrhea is possible, and you don't have to figure it out on your own. If this episode has resonated with you, I encourage you to take the first step, reach out, whether it's booking a discovery call with our office, or simply sharing your story with someone who understands you. Don't have to do this alone. Be gentle with yourself. Recovery isn't about perfection. It's about giving yourself permission to heal at your own pace, and if you're ready for support. We're here for you. You are worthy of health, energy, and a body that thrives. If you're ready to work with our elite team of healthcare professionals, go to our website, radiant clinic.com to schedule a free discovery Call with me and learn more about our package based pricing for comprehensive care. We are currently able to see patients for in-person appointments in our Cedar Rapids, Iowa Clinic, or can arrange for a telehealth visit. If you live in many different states, we are constantly adding new states to the areas that we serve. So check out our website for more details. Thank you so much for listening to this episode. Please share this podcast with someone in your life who would benefit from our services. Remember to subscribe to this podcast for more empowering content that I look forward to sharing with you on our next episode of Cycle Wisdom.