How to Get Your Period Back: The Key Role of Energy Availability in Overcoming Hypothalamic Amenorrhea
Wondering how to get your period back? One of the key factors of period recovery in the case of hypothalamic amenorrhea (HA) is ensuring you are providing your body with adequate energy.
HA is a form of secondary amenorrhea, in which someone experiences a 3 month or more pause in menstruation. HA is often confused with PCOS because they both can cause irregular periods. However, there are different root causes and it’s important to distinguish between PCOS and HA in order to determine the best path forward.
In this article, we are going to dive into the importance of energy availability for menstrual health and HA. We will also discuss strategies to ensure you are supporting your body’s needs to help get your period back!
Understanding Energy Availability for Hormone Health
How much energy (calories) we consume, compared to the energy we use up, are two key factors of energy homeostasis. Energy homeostasis is a tightly regulated balance that is critical for our bodies to function optimally.
Energy availability refers to the amount of usable energy available after accounting for energy used up during exercise. Ensuring we have adequate energy available is key for athletic performance, reproductive health, and nervous system support.
The hypothalamus in the brain is directly responsible for maintaining this important balance. It is also the starting point of a variety of hormone cascades that influence our reproductive health, nervous system and stress response, thyroid function, and more. These cascades include the hypothalamic-pituitary-adrenal (HPA) axis, hypothalamic-pituitary-thyroid (HPT) axis, as well as the hypothalamic-pituitary-ovarian (HPO) axis.
Low energy availability can be a result of overexercising, as well as inadequate energy intake or digestive issues that impact nutrient digestion and absorption. This is a prevalent issue among female athletes in particular. However, all women, especially those of reproductive age, are at risk of low energy availability.
Low energy availability is known to cause digestive issues, impaired cardiovascular function, low bone mineral density, cortisol dysfunction, and slowed metabolism. Low energy availability also directly causes HPO axis dysfunction. This dysfunction and the suppression of ovarian function and menstruation is an effort to conserve energy, but has significant reproductive repercussions, leading to period irregularity and conditions such as hypothalamic amenorrhea (HA).
Understanding Hormonal Changes in Hypothalamic Amenorrhea
Let’s quickly overview what happens hormonally in the case of HA. Gonadotropin releasing hormone (GnRH) is a key regulatory hormone produced by the hypothalamus that dictates the activity of the HPO axis. In HA, GnRH is suppressed, which results in low levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH stimulate estrogen and progesterone production in the ovaries. As you can see, the hormonal downregulation from the hypothalamus impairs hormone production all the way downstream to the ovaries.
HA, if untreated, can result in challenges that affect the whole body – fertility challenges, an increased risk for osteoporosis, and even cardiovascular challenges. These effects are widespread considering the importance of estrogen throughout the body, not just as it pertains to reproductive health. Because a major cause of HA is underfueling, or low energy availability, this is an essential area to zero in on to ensure you are supporting your body’s needs to help get your period back!
Without enough protein, fats, carbohydrates, and energy as a whole to fuel reproductive function, our body goes into this downregulated survival mode in order to protect us. Thyroid function and metabolism also slow down, making it a challenge to use hunger and fullness queues to accurately gauge whether or not we are eating enough.
Nutrition Considerations for Hypothalamic Amenorrhea
Macronutrients – Protein, Carbohydrates, and Fats
Ensuring adequate energy availability goes beyond eating enough calories. For hormone health, we also need to be mindful of macronutrient balance, that is, eating sufficient protein, carbohydrates, and fats. This is highly personalized, and your nutrition needs change during different life stages.
Based on your individual nutrient needs for overcoming HA and getting your period back, you may feel that your nutrition target is higher than what you are used to eating. Having smaller, more frequent meals throughout the day can help support increasing your energy consumption.
Eating enough carbohydrates is essential for getting your period back, and many of us are not consuming enough carbs! Adequate carbohydrate intake not only provides your body with an easy energy source, but it also supports the adrenal glands and helps bring down elevated cortisol levels, which is a common characteristic of those with HA. Cortisol is our body’s main stress hormone.
That being said, we still need to balance fiber-rich carbohydrate sources with proteins and fats in order to support an optimal blood sugar response. Both high and low blood sugar levels can fuel cortisol dysregulation and an activated nervous system.
Fats are also an essential macronutrient for reproductive health. Low total and saturated fat intake have both been shown to cause period irregularity and other issues such as HA. That being said, the quality and types of fats you are consuming are important to consider, and can either help fight oxidative stress and inflammation, or fuel it.
Micronutrients – Vitamins and Minerals
Fats also help absorb, transport, and store fat-soluble vitamins (vitamins A, D, E, and K) effectively. Fat-soluble vitamins are also key for ovulation and reproductive health. Other vitamins and minerals, such as vitamin D and calcium, support bone health and help prevent bone density loss that can occur in HA given the typical low energy availability and low estrogen environment.
Additional essential minerals include iron, zinc, and magnesium. These minerals all play critical roles in energy production, immune function, and nervous system support. Because of their widespread roles in the body, they are crucial for overall health and period recovery. These minerals and more can be found in a variety of food sources, as well as in a mineral complex supplement, like our Mineral Magic formula.
Minerals are also vitally important for the adrenal glands, again imperative for cortisol production and elevated levels in HA. Sodium, potassium, and vitamin C are all especially key for adrenal function.
Additional Factors to Consider to Get Your Period Back
Especially if you are in a low energy state, be sure to modify your exercise to help mitigate any excessive physical stress. When trying to get your period back, the balance between exercise and energy intake can look quite different compared to if you are cycling regularly. For those with HA, it’s important to prioritize restorative movement. This could involve yoga, pilates, swimming, or zone 2 cardio such as walking, very light jogging, or bike riding.
Modifying exercise to better support energy balance is one way of managing excess cortisol levels. Implementing stress management strategies like deep breathing, meditation, and practicing gratitude throughout the day can also help lower elevated cortisol.
Sleep is another factor to consider in the midst of hormonal challenges and HA. So many processes in the body are run on internal 24-hour clocks, or circadian rhythms. Sleep disturbances, whether you have trouble falling asleep or staying asleep, negatively impact these circadian rhythms. This has serious hormonal consequences, and has been associated with impaired metabolism, insulin resistance, diabetes, thyroid dysfunction, reproductive hormone imbalances, and appetite dysregulation.
The Next Steps To Getting Your Period Back
Energy intake and managing stress levels aren’t the only factors to consider with hypothalamic amenorrhea, although they are a critical place to start.
It’s possible that there are other biological stressors at play, that may be inhibiting hormone health and menstruation. This could include mold illness, hidden viral infections, digestive dysbiosis, and more. There is more to the puzzle than just caloric intake. That’s why it’s important to work with practitioners who are experienced in HA treatment, and who can provide a personalized nutrition plan. Check out our 1:1 coaching program for personalized nutrition guidance and support for your HA!
Written by Romana Brennan, MS, RD
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