Initially for personal reasons but the research that I do now is for my own professional development with clients; I developed an interest in hypothalamic amenorrhea (HA), a mouthful I know, but what even is it, why me and what do we do when we lose our period?
Well first things first it’s SO important that you go to see a specialist. Your GP is great if that’s what you can manage but I strongly recommend a specialist. GPs are wonderful but my experience in visiting them for the myriad of hormonal issues that I have had over the years has been less than helpful – they can’t be experts in everything after all.
HA is essentially secondary loss of our menstrual cycle – so you once had a regular period cycle but you ‘lost’ it. This could be for SO many reasons but for me, and many others, it was as a result of low energy availability. Essentially what that means is that we aren’t fuelling our daily physical activity adequately.
Our hypothalamus in the brain is essentially our ‘control centre’ and its job is to regulate many of our bodies’ functions, including the production of our sex hormones which alongside the pituitary gland and our ovaries functioning well, results in a healthy menstrual cycle. If things aren’t quite right though or the body is feeling stressed, physically or psychologically, because the body doesn’t differentiate well between the two (anyone experienced period irregularities during a stressful period at work?!), then the hypothalamus stops doing its thing; in turn our oestrogen and progesterone levels are impacted and ovulation and menstruation can ultimately stop which results in HA. As with everything, some people are more sensitive to stress causing these changes than others.
Physically though, which is so common in the health and wellbeing space, quick weight loss, excessive exercise or a restrictive nutrition intake can result in what is known as low energy availability which means that our body doesn’t have enough energy from our food to undertake all of the functions that it needs to for optimal health, including menstruating. What the body is trying to do is to downregulate some functions in order to conserve energy for functions that it deems to be more vital, like movement or keeping our brain functioning well. This is why, often when ladies lose their periods, they often also have symptoms like feeling cold all of the time or being ill or injured more frequently – there are bigger fish to fry for that body of yours!!
That state of low energy availability impacts way beyond just our menstrual cycle but many other things including our mental health, cardiovascular system and our digestive system.
I speak about hormones a lot, I also ask my clients regularly to mark their libido on a scale of 1-5 for me – the reason being that it is a great indicator of our hormone health, something which is absolutely pivotal for health overall, both physical and mental. The loss of our menstrual cycle not only indicates that our hormone health is compromised but has so many wider impacts, especially on our bone density. It therefore goes without saying that the loss of our menstrual cycle isn’t only an issue if you want to have children – it’s imperative that we repair that whether or not fertility is an issue for you.
Beyond fertility, repairing your menstrual cycle to what is normal for you will see your quality of life improve no end – even your performance day to day but also in your chosen mode of physical activity. I promise, despite our periods often inconveniencing our sporting endeavours, you will be a better athlete if your internal body is firing on all cylinders. High cortisol that comes with low energy availability can break down muscle mass and low oestrogen can result in reduced muscle strength, not to mention the psychological impact that HA can have. Lighter and leaner is NOT better. Alongside that, being in an energy deficit which is what is happening with low energy availability, is certainly not optimal for performance.
Low oestrogen has been linked in the research with cardiovascular issues as oestrogen is what we call ‘cardioprotective’. Low levels can present in blood work as high cholesterol – this doesn’t have to be long term though and when those hormonal functions are restored this often goes back to normal. High cholesterol as a result of under fuelling is important to recognise, another reason why seeing a specialist over a GP is a good idea, because ending up on a low-fat diet or with medication you don’t necessarily need is potentially damaging.
Loss of bone density is a biggie and likely the implication that you have heard of the most associated with low oestrogen levels, high cortisol caused by stress within the body and with lower than ideal nutritional intake, low vitamin D and calcium intake also likely, both of which support our bone health. As our bone density increases, we become increasingly vulnerable to things like osteoporosis whatever your age, stress fractures and injuries and recovery times from those things will be significantly lengthened. It is for the bone health implications primarily that hormone replacement therapy is now a common treatment while periods are recovered to deliver that oestrogen synthetically.
If you are in a state of low energy availability you will often notice negative psychological impacts – you might not necessarily be inherently living with depression but high cortisol levels, low oestrogen levels and a problematic relationship with food can severely impact your feelings of mental wellbeing from day to day.
You might read and be able to relate somewhat but perhaps don’t lead a hugely active lifestyle in terms of formal physical activity or be purposely dieting – you don’t necessarily have to fall into that camp in order to experience low energy availability or HA. Often women don’t even realise it’s happening as they may fly through their busy and stressful days forgetting to fuel and rest appropriately resulting in their HA risk increasing. You might even feel that you fuel appropriately over all BUT you also put yourself at risk if you are putting yourself within an energy deficit for a large portion of the day. Let’s say for example you ‘save’ a lot of your energy intake for your evening meal or you are partaking in fasting protocols or even something as simple as innocently skipping breakfast, you are still putting yourself at risk of HA. Something to bear in mind if your menstrual cycle isn’t quite right.
Training or exercising in a fasted state (not having eaten, often first thing in the morning) is something that became increasingly popular as a way to ‘burn body fat’ in years gone by – I’m here to tell you today that might not be the most appropriate way for you to manage your health. Our cortisol (stress hormone) levels are at their highest as soon as we wake up to get us up and about and energised for the day, exercising on top of this without taking the time to fuel elevates cortisol levels again leaving levels higher for longer – even sometimes chronically high contributing to the development of HA and that muscle breakdown that we spoke about earlier.
So, what can we do in order to protect ourselves against the loss of our periods? Well simply, first and foremost, fuelling appropriately and regularly, managing your physical and psychological stress and resting well around your physical activity. Easier said than done I know, the nutrition world is a minefield, but I am more than happy to chat generally to any of you about the fuelling of your exercise or even just a daily active lifestyle if you have an active job for example – we need to eat for human reasons aside from exercise after all!
If HA is something that you already live with, like I said, it’s SO important that you see a medical professional, it isn’t within my scope of practice to discuss my own or common recovery protocols, it is of course also very individual in method and in length of time taken. It can be VERY daunting if you have a complex relationship with food – I am with you, I understand. Be brave, this is SO important for your longevity. Always here if you simply want to chat.
Peace and love as always, A x
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