Disclaimer: I'm not a medical professional. What I share here are my personal experiences, backed by research and reading. For questions about your own condition and diagnostic help, please see your doctor.
What's Hypothalamic Amenorrhea?
At its core, HA is essentially period loss due to overexercise, under-eating, or excess stress. The 'A' in HA signifies period loss, while the 'H' indicates the origin of the condition is in the hypothalamus: your brain's hormone control center.
Those experiencing HA are essentially experiencing a strong signal, sent from their brain to their pituitary, telling it not to release the reproductive hormones that trigger ovulation [Read my post about how your period works here]. Why send these "stop" signals? Essentially, the hypothalamus is gauging your overall well-being at all times, tracking calories in and calories out, along with levels of your stress hormone, cortisol.
It's looking out for you, boo.
So if your hypothalamus hits the 'emergency stop' button on the moving bus of your menstrual cycle, its a strong indication that your body either isn't getting enough calories to support its own organs and develop a fetus, or your body is responding to too much stress to carry a child. [Check out my infographic key to HA signs here]
Considering my own story of losing 50 pounds post-pill, finding diet and exercise, and moving across the country to start grad school, it's likely obvious to you that I'm a type-A, always moving, always stressed lady. To no one's surprise, I was experiencing HA. Still, the diagnosis came as a shocking awakening to me.
Not only had I never heard of HA before my diagnosis, I had gone for 18 months without a period, thinking I had polycystic ovarian syndrome (PCOS) - an entirely different cause for lack of cycling, which is best treated through diet and exercise.
Note: Now's a good time to stop and read part 1 of this post about that PCOS diagnosis. Especially if you've been diagnosed with PCOS and aren't sure whether that's accurate.
When I finally did get the suggestion from my new doctor at the University of Michigan that HA could be underlying my period loss, she told me:
"You look a lot more like my athlete patients than my PCOS patients...they can sometimes lose their periods just from training too hard. It shouldn't be hard to get it back if you put on 8-10 pounds. But, if you like how you look and feel now, it's not a huge deal to lose your period for a while. You're at a healthy BMI and you look great!"
I know now that even this knowledgeable doctor, who deals significantly with HA among hundreds of Division I college athletes, was perpetuating extremely harmful diet culture rhetoric. When she told me I was "healthy," with HA, she was prioritizing Western beauty standards and arbitrary BMI numbers over the clear indication from my own body that I wasn't well. And its not just one doctor perpetuating these standards – considering zero doctors had mentioned HA in prior diagnostic conversations, all of my prior doctors had spouted the same harmful norms. I know now this is the experience of many, if not most HA patients. And that's why I started this blog.
But, diagnosing errors aside, there is so much more to discuss when it comes to HA and period loss. And a lot of it, I learned on my own, through reading, watching YouTube and listening to podcasts. In this blog, I aim to share what I learned her in an easy-to-process way, to spread and re-share some of the love and learnings I got from the HA community. In specific, however, for now, I'll point out just one insight. Author (and personal idol) Lisa Hendrickson-Jack has a whole book discussing how your period is a vital sign of your health, just like your blood pressure or body temperature*.
Bottom line: losing your period is not a sign of physical fitness, vitality or athleticism. It's a sign you're putting so much on your body that it's decided to prioritize certain organ functions over others.
For me, as I mentioned before, learning I had HA was an awakening. It was the trigger that I'd gone too far in my weight loss journey.
While I had previously praised myself for my daily commitment to MyFitnessPal calorie tracking and hot vinyasa flows, early evidence from my HA investigation suggested these behaviors were actually making me sick. And in fact, to get my period back, I'd have to stop moving so much and start eating more. I'd have to cut out the #dietculture bullshit all together for a few weeks, if not a few months, and commit to eating 2500 calories a day and moving less.
My first thought was "ouch."
To someone who had spent the last 2+ years calorie restricting and exercising a ton, this "R&R" sounded like torture. But, it would restore my health and the possibility of my future babies. It would be oh so worth it.
*Resources:
Lisa Hendrickson-Jack: Fertility Friday (podcast) and The Fifth Vital Sign (book)
The Encyclopedia of Endocrine Diseases offers Hypothalamic Amenorrhea's detailed scientific explanation, making the immediate and unfortunate connection to eating disorders, which are certainly not always to blame for HA.
You may have heard of "athlete's triad" which is the combination of 'distorted' eating, amenorrhea and osteoporosis found in athletes. Osteoporosis is one of the significant long-term health ramifications of not cycling. Academic paper about this.