Hypothalamic amenorrhea and how to get your period back naturally
This post is mainly written for other women who were diagnosed with hypothalamic amenorrhea at some point of their life. But if there’s someone reading who’s not familiar with the term; hypothalamic amenorrhea (HA) is a condition where your period is missing because one of the control centers in the brain, hypothalamus, shuts down the reproductive system in order to save energy for more important bodily functions, like breathing and blood circulation. Main causes of hypothalamic amenorrhea are overexercising, undereating, stress, and losing weight too quickly. In most cases, the doctors try to put you on birth-control pill to make you bleed regularly. But that’s no solution to the root problem.
Usually, I don’t write about weight or post pictures of my body but I know how important details are for women desperately seeking information. I was there, too. “How much weight do I have to gain? Can I still continue lifting weights or do I have to stop exercising totally? How long will it take to get my period back? Will I ever be able to exercise like I used to?” We all have different histories and different reasons for hypothalamic amenorrhea. Likewise, the same actions don’t work for everyone – some may need more time, rest, and food. But hearing recovery stories brings hope that one day it will all get better.
How I lost my period
I’ve always loved food and living an active, sporty, and outdoorsy life. Already in school, I used to eat huge portions at lunch and wondered how my friends survived with such a small amount of food. My relation to food and my body was healthy since I was naturally lean and felt good in my body.
Around 2012 I got the idea of toning up a little by doing some strength training and building more muscle. I started going to the gym 4-5 times a week and started eating even more. I fell in love with lifting weights, being strong and powerful. Since I didn’t restrict my eating too much, I maintained a healthy weight and menstrual cycle. My weight had for long been around 52-53 kg, which for a 167 cm tall woman is a normal BMI of 19.
During the past five, six years I’ve had some short trials with different diets. I followed some sort of Low Carb & High Fat -diet for maybe 6 months but I still ate fruits and got enough carbs to maintain my period. I actually gained some weight because at that time I knew nothing about healthy fats. I just added cream and cheese to my diet and left out bread and pasta. Now I understand more about nutrition, thanks to the Bulletproof Diet. I also tried being vegan, and that lasted for 4 months. During that time I started having bruises very easily and felt pretty tired in general. I ate a lot of carbs and my period stayed normal.
The challenges started in early 2016 when I got on the Bulletproof Diet. It is a high-fat, low-carb diet that minimises anti-nutrients and toxins by choosing organic foods whenever possible. I started adding fat to my diet, yet not going low enough on carbs, which made me gain some weight. I was heavier than ever, 55 kg. I started restricting both fat and carbs – not a good idea! I kept on eating big portions, and about 2.000 kcal daily while keeping the carbohydrate amount very low, close to a ketogenic diet (less than 50 grams of net carbs a day). I also introduced some biohacking routines, like fasting and cold showers, to my everyday life. Having heard and read so much good about fasting and how it may stop the cancer cells from growing, I started doing intermittent fasting and later added a weekly 24-hours fasting to my routine. Being active in the biohacking community, I wanted to challenge myself with longer fasts like the others (mostly men!) were doing so I did a few 40-hours fasting experiments. I didn’t realize that I should eat much more during the other days.
In a few months, I was back at my normal weight (52-53 kg) and stopped thinking about the number on the scale or how my body looked like. The new lifestyle and diet had stabilized into routines which felt good. I enjoyed eating a lot of vegetables, avocados, coconut, eggs, salmon, butter, meat, and once a week sweet potato or rice as a carb refeed. I exercised every day. Just because I really enjoyed doing that and it was the only way I could relax my body. I did everything that’s supposed to be super healthy. In about 6 months, my weight had dropped to 46 kg (BMI 16.5).
My period actually stopped before I lost this much weight – I think it was mainly because of the stress and energy deficit caused by the low carb diet and fasting protocol. On top of that, losing weight made my body shut down the reproductive system all in all. Everything else was fine so I didn’t worry. I felt great in my leaner and toned body that was super energetic and strong. But in my head, I was in a prison of restrictions and fear. I knew I couldn’t stay that small forever and I definitely did not want to lose any more muscle mass. At the same time, I was afraid of eating carbs and gaining weight. I learned that having the perfect body didn’t make me happy. I was constantly worried about something related to my body, weight or food. Only after letting go of the control, I understood how deep in my mental prison I was. I just wanted to be alone all the time because food and exercise were taking all my energy. I always ate alone and hated the idea of sharing my food with someone else. I got anxious in social situations where food was a part of the event.
Seeing this picture taken in May 2017 made me realize how skinny I was. Then I decided to start eating more carbs to try to get my period back. The selfie on the right I took in November 2016 when my BMI had dropped to 16–17 and I was training hard. I could see my veins too clearly and my fat percentage was way too low. But at that time, I didn’t see any problem with my lifestyle.
What I did to get them back
It took quite a while to admit that something was wrong. I felt great in so many ways, and my lifestyle was seemingly perfect. But when it goes too far, it’s not healthy anymore. At some point, I saw my gynecologist and she told me not to worry and that I only needed to come back if I wanted to get pregnant. She thought that missing period was no issue unless I wanted to have children. So I didn’t worry and moved on with my life.
After a year I started researching again and found out that missing periods and the lack of estrogen can cause quite severe health problems in the long run; loss of bone mass and increased risk of heart disease, not to mention the difficulties of getting pregnant if desired. So I went to see another gynecologist who did a blood test and sent me to an endocrinologist (hormone specialist). My estrogen was close to zero, and after a functional blood test, I was diagnosed with hypothalamic amenorrhea. Years ago I had been told that I might have PCOS but that was now ruled out. There was basically nothing else wrong with my body other than that my brain just didn’t send the message to the ovaries to produce the hormones needed to maintain a menstrual cycle.
The suggested treatment was taking either birth control pills or using an estrogen spray together with a progesterone pill. I was leaning towards the estrogen spray which was a milder version out of the two options. But I was hesitant to start taking artificial hormones. I had read so much negative about birth control pills and had decided never again to go on the pill. I read that the bleeding you get while you’re on the pill is not the same as the natural menstruation you have without any pills. Also, the hormonal replacement therapy does not fix the root problem and it just masks the symptoms. How do you know if you are recovered if you just keep on taking the pills?
I found a book called “No period. Now what?” written by three women who themselves recovered naturally from hypothalamic amenorrhea. They also founded an amazing support group for thousands of women in the same situation. So many women regained their cycle just by eating more, without any restrictions, and resting more. For most, it meant stopping exercising totally for a while. I knew this had to be the best fix to my problem and wanted to give it a try before going on any pills.
How I changed my lifestyle
- Reduced the amount of exercise. I didn’t go to the gym as often, and during the last months, I did hardly any workouts. Mainly I just went out for walks, leisurely bike rides or did some yoga at home.
- Gained weight from 46 kg to at least 55 kg (BMI increased from 16.5 to about 20). I have weighed myself only once after going all in, and based on how tight my clothes now feel, I think I’ve gained even more. Might be that I’m not done yet since the optimal BMI for fertility and natural cycles is 22–23. I hope that after some time my body will find its’ natural set point again.
- Started sleeping much more; about 9-10 hours every night, compared to 7–8 hours before. I also started sleeping later in the mornings (until 7 or 8 am) and not waking up at 5 am anymore.
- Stopped fasting, taking cold showers, and drinking coffee to reduce stress.
How I changed my food
- Started eating much more carbs every day
- Started eating so-called unhealthy foods every now and then (bread, candy, wine, cheese, etc.)
- Started eating more evenly throughout the day; breakfast, lunch, snacks, and dinner
- Stopped controlling the amount and timing of foods – I let myself eat whenever I was thinking about food
- Stopped thinking about which foods should not be eaten at the same time (for example, combining fat and carbs was scary before because that had caused me to gain weight)
Which supplements I started taking
- After going “all in”, I started supplementing more regularly: Vitamins D, K, C, and B, Fish oils (EPA/DHA), Acetyl-L-Carnitine, Magnesium, and Zinc. Being in Europe, I order my supplements from LiveHelfi.com or Amazon.de.
- For the first month, I added Maca root powder to my morning tea and took Ashwagandha pills in the afternoon. Note that Maca powder should be heated or boiled to activate the ingredients. It’s also easier on your stomach.
- For about a month, I also took Roseroot Elixir (Rhodiola rosea) on a daily basis to help my body recover from stress and jet lag after traveling to the U.S.
I started taking Acetyl-L-Carnitine after reading this article. I noticed right away that my face was full and bloated. Recently, I learned that ALC can also cause troubles with sleeping. After my first recovery period, I’ve tested skipping ALC a few times – I’ve slept much deeper and my face doesn’t seem quite as bloated on those days. But I want to keep on taking ALC until I’ve had at least three periods.
And they came!
After reading about the topic, I knew that on an average, it takes 5 months to get your period back. My story was quite a typical one. I started making some changes to my diet in July 2017 by eating more carbs. I continued exercising and fasting until September 2017 when I went “all in”. After that, I still did some biking, yoga, and even went to the gym a few times. But mostly I was relaxing, sleeping more, and eating much more (especially more carbs). And after 19 months my first recovery period started December 2nd, 2017! What a relief! Even though I feel uncomfortable with the current weight, I’m so happy that I’m healthy again! I don’t need to worry about my bones and heart so much anymore. Mentally, I feel much more balanced, understanding, and gentle than I used to be.
For the next months, I’ll try to continue taking it easy. I also should maintain my current weight even though I’m not comfortable being this heavy and out of shape. I’ve started doing some strength training again even though it’s not recommended so soon after your first recovery period. If it seems that the second period is not coming, I need to skip training again. I ordered the new OURA Ring which will help in tracking my sleep and recovery. Hopefully, that will also help in keeping my exercise and activity at an optimal level and not stressing my body too much. Also, the ring shows the deviation of body temperature which will be helpful in identifying the timing of ovulation. Even if you’re not trying to get pregnant, it’s a good way to learn how your natural cycle works.
What I learned during the process
- TO RELAX – Before I couldn’t relax without going to the gym, doing yoga, or biking. Now I can just sit at home and watch a movie, which I never did while being on the high-performance-mode. I was always doing something and didn’t want to waste time on something “pointless”, like watching a movie.
- TO ENJOY MORE – Life is meant to be enjoyed. If you’re constantly controlling what you eat and try to maintain certain body figure, it takes way too much effort compared to the benefits of just going with the flow.
- A ketogenic diet, an extremely low-carb diet where your body starts using fat as fuel, is not good for me.
- Even though I was always eating at least 2.000 kcal a day, it wasn’t enough for my activity level.
- If you restrict certain food groups, like carbs, you easily cut out too many calories from your diet and lose too much weight.
- Traditional doctors know nothing about nutrition. None of them ever asked what and how much I eat. Usually, I pointed out that I’ve been on a low carb diet, asking their opinion if that could be the root cause. ” I don’t think so”, they said and changed the topic.
- If you have a hunch about the root cause of your hypothalamic amenorrhea, try to fix it first.
- Women need an adequate amount of fat in their body to maintain the normal menstrual cycle. At my lowest weight, I had no curves what so ever, and now I’m trying to focus on the positive sides of gaining weight.
- Women’s hormones react easily to stress; fasting, exercise, and restrictive diet may increase cortisol and lower estrogen level.
- I also learned to tolerate my bigger body even though I don’t love it right now.
Resources that were helpful in my recovery
- The Book “No period. Now what?” and the Facebook support group – The most comprehensive and supportive resource for women struggling with hypothalamic amenorrhea!
- Blog “Paleo for Women” by Stefani Ruper – This was helpful in understanding how much I need to eat carbs (150–200 grams daily)
- Bulletproof Radio, Episode #415 with Dr. Jolene Brighten – Confirmed that I should not go on the pill
- Blog and Podcast by Laura Schoenfeld – Made me question if I really have to stop exercising totally
- Lara Briden’s Healthy Hormone Blog – Also confirmed that I should not go on the pill
Was it just because of the Low Carb diet?
I don’t think so. It was probably the combination of low carb and high activity that put my body into an energy saving, survival mode. I can’t say that low carb is bad for all women. But I suggest thinking twice before restricting foods in your diet, especially if you are athletic. I still believe that the foundation of the Bulletproof Diet is golden, and I do want to keep most of the principles in my life. But the diet really needs to be adjusted to every single one of us. I’ve learned so much about listening to my body and, hopefully, I continue getting better in providing all the rest and nutrients my body needs to recover fully.