There are many different problems that can cause women to stop menstruating. In rare cases amenorrhea comes from genetic defects and physical abnormalities. These cases usually require medical intervention.
More commonly, women stop menstruating due to conditions like PCOS or hypothalamic amenorrhea, both of which are highly influenced by (and overcome with) diet and lifestyle choices.
Because there are so many possible causes of amenorrhea, the most important thing you can do to overcome a problem with your fertility is to investigate.
Figuring out your problem is the first step towards solving it.
If you once had normal menstrual cycles but now do not, there is a very good chance that some underlying health problem is the culprit. PCOS, like I mentioned, is one potential culprit. Another potential and common culprit is hypothalamic amenorrhea.
In this post I discuss hypothalalmic amenorrhea symptoms and causes. This will help provide a road map for your healing – and will hopefully help you get moving in the right direction.
What is hypothalamic amenorrhea?
Hypothalamic amenorrhea is the technical name for when the hypothalamus stops sending “go ahead and reproduce” signals to the pituitary gland. This results in menstrual cycles being lost, along with other symptoms.
The primary hormone used for this signalling process is GnRH (gonadotropin releasing hormone). The hormones that the pituitary gland would then ordinarily produce but in hypothalamic amenorrhea fails to do so are LH (luteinizing hormone), FSH (follicle-stimulating hormone), and prolactin. Hormone levels that then fall as a result of those hormone levels falling are estrogen, progesterone, and testosterone (usually – though sometimes some of these may stay elevated for complicated reasons).
I like to think of the system a set of dominoes: hormones are produced in a cascade. If there is no agent (the hypothalamus) that knocks down the first domino at the beginning of the process, then none of the dominoes (hormones) get knocked down. Hormones do not get made if the hypothalamus does not tell the pituitary gland to make them.
A staggering 10% of American women suffer from hypothalamic amenorrhea at some point in their lives. And interestingly enough, hypothalamic amenorrhea is not confined to humans! Other primates also experience impaired fertility and lose their menstrual cycles due to hypothalamic dysfunction.
Hypothalamic Amenorrhea Symptoms
There are many symptoms of hypothalamic amenorrhea. These are the most common:
-Loss of menstrual cycles, or sometimes very light bleeding
-Failure to ovulate
-Low libido
-Sleep disturbances
-Depression, anxiety, or other chronic mood symptoms
-Cystic acne (occasionally, especially when you simultaneously have PCOS)
-Low energy
-Constant hunger, or changes to hunger cues
-Always feeling cold
-Other symptoms of hypothyroidism, which often accompanies hypothalamic amenorrhea, such as brittle hair and nails
These are problems that are a result of hypothalamic amenorrhea. There are many other signs that may indicate or even cause hypothalamic amenorrhea. They are:
-Low body fat percentage
-Rapid weight loss
-Excessive exercise (different for every woman – challenging workouts 1 or more times a day is generally a good, rough guideline for too much)
-Stress
-Low fat diet
-Low carbohydrate diet
-Low calorie diet
Causes of hypothalamic amenorrhea
There is a common theme to the “signs” of hypothalamic amneorrhea I listed above:
each of them are a threat to a healthy pregnancy.
The science of this takes us back millions of years.
Way back in human history, when people hunted and gathered on the savannah, it was very important to be in a safe environment while pregnant. Famine could very easily kill a pregnant woman. Starving could very easily kill a pregnant woman. A stressful circumstance like war or a long hike could also be too much for a pregnant woman to bear.
Any sign of an “unsafe” condition on the savannah was life-threatening to a pregnant woman. In order to prevent pregnancy at an unsafe time, the female body developed a very keen sensitivity to starvation signals.
When the body detects “starvation,” it shuts down reproductive function. This prevents you from becoming pregnant while stressed – something which might very well have killed you on the savannah.
Having inadequate food, losing a lot of body weight, exercising a lot, having a low body fat percentage, eating too little fat or too few carbohydrates, or being under extreme emotional duress are all important starvation signals.
When we mimic these life-threatening savannah conditions in the modern world – and we do this so often by starving ourselves for the sake of diets, slenderness, or for atheltic goals – our bodies respond with the old programming of hormonal shut-down.
Hypothalamic amenorrhea special case: birth control pills
One final yet important thing to discuss about hypothalamic amenorrhea is what happens when women come off of birth control pills. Sometimes, women do so without any problems. Yet quite frequently when women come off of birth control they stop menstruating.
The reason this happens is two-fold: 1) while on the pill, the liver is responsible for filtering out “old” hormones. Sometimes hormone surplus builds up in the liver, such that when you come off of the pill the body still feels like it’s on it because the hormones are being released into the bloodstream by the liver.
2) The body does its best to maintain stable hormone levels throughout time. While on the pill, hormones enter the body from the outside. This means the pituitary gland doesn’t have to work as hard as it used to. Then, when coming off of the pill, the pituitary gland is still “lazy” and takes some time to kick back into gear.
Sometimes this problem of being infertile coming off of the pill takes several months if not a year or two to overcome. Sometimes it is primarily a hypothalamic amenorrhea-type problem – other times it is more like PCOS.
In all cases, a nutrient-rich diet full of organic vegetables and fruits, organ meats (here’s a supplement in case you do not like to eat liver), eggs, fermented foods (here are my favorites) and the rockstar superfood cod liver oil that focuses on eating more rather than less will almost always greatly accelerate healing.
I also happened to write a guide on birth control options and how to be as healthy as possible while using them (or not) – which you can read about and download here.
Hypothalamic Amenorrhea Symptoms: What to do about them
The solution to hypothalamic amenorrhea is simultaneously complex and simple. It is complex because every woman is unique and must meet her own specific needs. It is simple because it very often boils down to two very simple principles:
Eat.
Relax.
Repeat.
In hypothalamic amenorrhea, women suffer because their bodies want love. They want nourishment. They want reassurance. They want to feel safe and to feel fed. I talk about this in more detail in this post – but really most of all what it all boils down to is eating and love and eating and love.
And that is it for hypothalamic amenorrhea symptoms and causes. What do you think? What are your hypothalamic amenorrhea symptoms? What caused your hypothalamic amenorrhea? Then head on over to this post and tell me all about your progress on your journey overcoming it!
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After gaining a bunch of weight after last summer, I went to extremes by intense training and cutting carbs out almost completely. I lost weight, and fast – but also my period. After a few months, I started eating more carbs (LOTS of oatmeal, more fruit, sweet potatoes) and my period came back. Then it started all over again.. I realized the weight I had gained from getting my period back, and I started the cycle again. I now haven’t had my period since February, and I believe I self-induced other problems – leaky gut, which led to some food sensitivities. I took an allergy test and found that not only do I have a candida overgrowth, but also am sensitive to wheat, barley, rye, oats, rice, and yeast. Right now my focus is on exercising less, and eating more starchy carbs (sweet potatoes, green plantains) and occasional berries/green apples to hopefully get my period back asap! I can’t believe I did this to myself again :/
Hi
I hope things improve for you.
I was just wondering, how did you do the allergy test? I live in porridge and pasta and had slim PCOS. Had a 14wk miscarriage, then conceived taking Inofolic. Now have a beautiful little baby boy.
But… 6 months post partum and I am fatter than even during pregnancy (arms and legs I mean). I need to seriously take control of my eating and also be kind to body as am breastfeeding.
Based in uk.
Thanks in advance.
Hi Stefani! First of all, thank you for sharing your incredible knowledge with the world. I suffered from HA for 1 1/2 years after coming off of long term use of birth control. I also had a fairly low body fat % and exercised quite a bit. When doing research on how to resolve this I came upon your blog and podcast. I put many of your recommendations to action. 4 months later after making lifestyle changes and adding a few supplements, my cycle came back! I have now had it 2 consecutive months. Thank you!
What supplements did you add?
Thanks Stefani for the great post! By the way I love the podcast! I am currently suffering from this myself after having my first(and currently only!) baby almost 3 years ago. This has been an extremely trying time since i’ve kept up the nutrient rich foods, yes even liver, dialed down exercise and stress but still don’t even have an irregular period! I’m hoping my new functional medicine doc can help me more but it’s great to know that there are other women out there dealing with this same issue
I’m going through the same thing as you Rachel. I have a nearly 2 1/2 year old boy and no sign of a period since his birth. It’s so frustrating going through it. A concern always in the back of your mind, which you try not to stress about! I hope you have luck with the functional medical doc.
Hi Stefani,
I love your blog! I have been having period issues for many years, and they have been nonexistent for quite some time now, (aside from 2 months when they were super light). My boyfriend and I follow pretty grain free, somewhat paleo lifestyle, more Primal than Paleo. I have always been really into fitness and supplements/health, and do things now like long walks, occasional short jogs, and yoga. Until the past 2 or 3 years I was not being super intentional about trying to get my cycles back, and it has always been an issue, as I have hormonal fluctuations, but never actually bleed. Until about one year ago, I never really attributed it to “hypothalamic amenorrhea” until my boyfriend, (who is a chiropractor) thought it was likely due to low body fat, as I’m about 14-15%, but I don’t look unhealthy, just fit. I have been very intentional at adding more starchy carbs, I take Standard Process( which are glandulars from animals), Great lakes Gelatin, iron, multiple oils, Cod liver oil, and eat a variety of healthy foods. Currently my stress is minimal, as I finished Nursing school about 3 months ago. I would say my main activities are walking the dog(long walks), and stretching and yoga. It has become frustrating, as these issues started in my mid -late 20s (at the end of my undergrad), and now I am 35 and getting ready to start my new job as a nurse, so just want to go into it with overall good health. I have tried: acupuncture, chiropractic:), Multiple supplements( which give me energy but no cycle), I also have done “seed cycling” and lunaception, which did help for a bit(lunaception is keeping blinds open around the full moon). I am a very holistic and natural person, but would like this issue to get sorted. It has been going on for 7 + years (light to irregular, to NO cycles the past 2 or 3). I understand other women being frustrated with this issue, but for myself, I’m not doing intense cardio(running, cycling, so on) like I used too. It just seems like an issue we have to be patient with. I will add that deep down I really do not think I need to gain weight, which adds to the issue, as I feel I’m healthy looking.
My boyfriend found your blog a year or two ago, which is what zoned him into the fact things were related to low body fat!
This post is long, just wanted to share my personal experience, and it makes me feel a part of a “group” as others have this same problem:)
Val:)
Thank you for such a great article! and I’m not even done reading it yet . . . I have HPA and am about to start a sugar detox and then on to Paleo from there. Under the guidance of a nutritional therapist. I’m 38 years young and sick of treating this with synthetic estrogen (Estrogel). I also had adrenal fatigue year ago and suffer from depression. Cold all the time. These symptoms are SO me.
How do you know then if it’s hypothalamic amenorrhea vs. post-pill amenorrhea? I came off of BCPs 2 months ago and have yet to ovulate and have a period. I do have a history of over exercising and under eating, but my current weight is normal at a BMI of 23. If it was a matter of eating more and resting I definitely would as I’m trying to conceive, but I’d hate to gain a bunch of weight if it’s just post-pill amenorrhea! I’m so frustrated and not sure what to do. I had my hormone levels drawn and LH and FSH were normal (but on the low side) and estradiol was low at 20. I had an ultrasound done and there were small follicles on my ovaries. Do people with hypothalamic amenorrhea still produce follicles? Thank you!
I have HA and I produce follicles but don’t release eggs… 🙁
accidentally found mysef eating dangerous low carb/low call for a few months trying to troubleshoot a health issue and now dealing with hair falling and ammenorhea, and im trying to just fix my diet and add in methylated bvitamins and be patient, since im pretty sure my hair loss now is due to weight trauma that occured several months ago. but, is there a role for iodine in this in your opinion? i dont eat sea vegetables and only use sea salt, and a few months passed that way before i panicked and picked up supplemental iodine, but i have no way to know if it is helping or harming.
honestly I don’t think so, I’d just eat more (for the HA). supplemental iodine can throw off your internal balance with other minerals if not taken properly. if you do decide to take it i think a low dose would be good, and make sure you take or are getting in your diet selenium as well.
Hi there! Thank you for sharing your blog post! In the last two years, I have been working hard to get “those abs” I’ve always wanted. I lost about 20 lbs and sit at 131lb for 5’9″. I am nervous that i have a combination of HA and post-pill amenorrhea. I am going on 5 months without a period after coming off BC. I rarely had a period while on it the last couple years. I eat well, usually 2209-2500 calories a day, with 270g carb. I am a bike commuter- which burns around 450cal on weekdays, plus a 45-60min strength training workout that usually burns from 250-500. Not sure if I should find another way to get to work? Add more food? My strength training isn’t super intense… My doctor told me to contact her if I continue to have this problem for 6 months… Hard to wait as we are trying to conceive. :/ any advice is appreciated!
I’m in a similar situation. Can you please advise? I eat well, but am slightly underweight.. did you add more food or did your period come back naturally after BC?
Stefani,
Thanks for your post! I am truly struggling right now. At age 14 I was diagnosed with PCOS and went on birth control til I was 27. Last January, I stopped taking birth control because my husband and I wanted to start a family. I had also recently lost 50lbs that previous year and trained for and ran my first half marathon. My BMI was and still is normal at 24.9. After stopping birth control and losing all of that weight, I never got a period. 5 months later, my reproductive endocrinologist ran some tests and told me I did not have PCOS but Hypothalamic Amenorrhea. I felt so angry because I lost all that weight thinking it would help me conceive but really it just made my body stop working! My RE put me on Provera to induce menstruation and then Clomid. I responded to Clomid but did not conceive. We recently upped the dosage of Clomid but I did not ovulate at all that time. Now I am just confused and desperate for my body to be normal. I was researching high estrogen foods and will start eating more of those. I already eat mostly paleo, low gluten and I feel I eat plenty of calories. My weight has maintained, but I am not overweight so I feel that is OK. I also still run 15-20 miles per week which is pretty healthy and normal. What else do you suggest I do? I am desperate… thank you 🙂 -Megan
Unfortunately IF you have some sort of autoimmunity going on (and I have no idea, of course) ‘low gluten’ would be insufficient to help. Just so you know, you really do have to eliminate it to see if you have any sort of reactivity issues.
Have you read my post about being able to have hypothalamic amenorrhea and PCOS at the same time? It seems like you may have some PCOS tendencies and then the HA also became a factor with long-term pill use and weight loss. To be honest having been on the pill for 13 years, I’m not surprised your fertility hasn’t quite come back yet. It takes some women more than a year to regain regular cycles. With PCOS and HA on top of that I think some serious patience is required. Plenty of carbs and fat and stress reduction… you know, the usual. I might say that the pill use is actually more of a factor here than the weight loss. I mean they are all at play, but I really do think, again, that some patience is going to be necessary.
Stefani,
Based off of your knowledge and experience, can psychological stress alone be enough to cause and prolong hypothalamic amenorrhea? I have never been underweight, restricted eating, or over-exercised, and yet I have been dealing with hypothalamic amenorrhea for a year. I have not had a single, significant stressful event take place over the last year, but have instead been in a constant state of higher stress over the last few years. Maybe it is finally catching up to me? My last period was February 27, 2015. After about 3 months without having a period, I went on low-dose BC to see if it would help. I lightly bled non-stop while on BC, and therefore stopped taking it 2 1/2 months later. That was in the middle of July 2015. I have since had absolutely no bleeding. My estradiol, progesterone, LH, FSH, and thyroid levels are all very low. I’ve been checked for hypothyroidism (don’t have high TSH), a pituitary tumor, and PCOS, and all results have come back “normal.” Clearly, my body is not normal right now! I’m getting quite concerned about the long-term effects of having low levels of estrogen, and I am even more concerned about regaining my fertility, as my husband and I were hoping to start a family soon. I have gained 15 pounds (now 5’1″ and 127lbs) and barely exercise. I’m just not sure what else to do, and the stress this situation is causing is only making things worse! I have been researching my buns off and listening to a ton of podcasts, but have yet to come across another person that has experienced hypothalamic amenorrhea without some kind of physical stress causing it. I would so love and appreciate and if you could share your thoughts with me!
<3 Kelli
Stress can DEFINITELY be the sole cause. It sounds like you are working with an OBGYN which is great, because they can rule out any other physiological problems you may be having. I’d give it a few months of serious stress reduction and if that doesn’t do it, then looking at other avenues. It’s possible you have hypothyroidism, for example, which is causing all the other hormone levels to be low?
Hi Stefani,
Just hoping to get your opinion on my current situation,
I am 25 and lost my period at 21 after losing 15kgs over the course of 6months. Before losing the weight I was classified as “overweight’ on a BMI scale. I got down to a BMI of 21 and have stayed pretty much exactly that for the last 4 years. This was done by cutting out excessive amounts of take away/ “junk food” and i started walking about 10kms a day and continue this. This is the only exercise I still do.
I still haven’t got a period back after 4years and my doctor diagnosed me with ‘hypothalamic amenorrhea’ but wasn’t so concerned about this as I am not really wanting to have children.
My main concern is that I have been suffering from VERY intense constipation for the past 2 years and its progressively gotten worse. It is to the point now where I do not want to do anything social, I am worried about ANYTHING that I eat because generally food will make me feel sick and adds to the epic build up around my lower stomach. I will go weeks without going. I have no sex drive at all and just feel horribly bloated and sick ALL the time. I have been diagnosed with IBS and slow transit constipation.
After having a colon transit study, my gastroenterologist diagnosed me with slow transit constipation and told me that my body just can process fibre, and to eliminate it from my diet. This made things worse.
My main question to you is do you think OR have you heard of such bad constipation issues being a symptom of hypothalamic amenorrhea?
My doctor suggested that IF i did want to get my period back that I may need to get back to the weight i was before I lost it. putting me at the very border line of being almost classified as “over weight” on the BMI scale. Which is something i would prefer not to have to do as im not 100% sure the reason for my HA is due to my weight/body fat…. doctors have told me that because I lost my period straight after the weight loss this is the reason. But as I said i am by no means ‘underweight’ and i definitely have a fair amount of body fat. Im not very lean or musclar. So im just a little confused as to why I have lost my period and have not gotten it back yet..
For me, fertility isnt really something I am concerned about but I feel I can no longer live with this constipation issue, and if getting my period back will assist with this issue I am definitely willing to… I just dont want to put the weight on (as it is quite alot) and have no improvement with my stomach issues.
Sorry for the lengthiness.. just mainly wanting to know if you know many cases where the two (HA and chronic constipation) have been linked.
I am thinking of trying intermittent fasting and more exercise in the hope that my period will (a) stop completely (probably too much to hope for) or (b) decrease to a more manageable level. I currently don’t exercise much except for a 45 min walk 5 times a week. So I have room for improvement there too. I am worried that if I fast I’ll lose weight and I am currently in the “underweight” range of the BMI chart (possibly a side effect of medication) but I was always in the lower end of the “normal” range.
Over the past 3 years my periods have got so bad – heavy bleeding, severe cramps, migraines, vomiting, nausea that I just want them to stop.
Fortunately at the moment I am on Zoladex which has stopped my periods (and given me other side effects) but my doctor said I can only stay on it for 6 months max and then she’s hoping my hormones will “reset” themselves…
It’s possible the reset will happen, though it’s also possible it won’t. I’m very sorry about your severe pain, but as appealing as starving yourself may seem in the short run, I’m not sure it’s a good long term solution. Have you tried inflammation-reducing, gut-healing strategies? Magnesium supplements? The thing is, progesterone becomes low when you undereat and are stressed, and if you don’t have enough progesterone your estrogen levels take over and can be a part of making your periods more painful. Have you considered gaining weight as a strategy to try and find more relief? I’m not saying that’s necessarily the answer but it could be
Could dermatitis also be a symptom of this? I have never experienced acne in my life and currently, at 37, have developed dermatitis and cystic acne at the same time! We started intermittent fasting (eating all of our meals between Noon-6) and I’m thinking after reading this that this may have stressed my body too much. But it really helped my energy levels!! Anyway, thank you for the post.
mmm, yes, the body can produce extra stress hormones when fasting (i ALWAYS get a new zit or two if i make myself go all day without eating), and I think this could contribute to dermatitis too