Why did I lose my period?

And how can I get my period back?

As annoying as they may be sometimes, periods are a really important part of your health and wellbeing. So when they go missing, it’s important to check-in with your GP or gynaecologist.

Before we go any further, let’s clarify the type of ‘missing period’ we’re talking about in this blog. This blog is going to cover secondary amenorrhea. This is different to primary amenorrhea in which periods have not started during puberty as expected. Secondary amenorrhea however is when, following regular menstruation, your periods having been missing for three months or more and other cause (such as pregnancy or PMOS) have been ruled out. More specifically we’re going to be talking about a type of secondary amenorrhea called hypothalamic amenorrhea. If you’ve had a diagnosis of hypothalamic amenorrhea, keep reading. If you haven’t had a diagnosis of hypothalamic amenorrhea, you may also wish to keep reading however it’s important you arrange a check-up with your GP or gynaecologist too.

What is hypothalamic amenorrhea?

Hypothalamic amenorrhea gets its name because it all starts in a region of the brain called the hypothalamus. Your hypothalamus is like your body’s control centre. Unlike the headquarters from the Inside Out movie, your hypothalamus has more of a home maintenance role in that it controls things like temperature, sleep cycles, hunger and thirst, and reproduction.

If your brain detects your body being under too much duress, it puts reproductive function on pause through a process of downregulating production of several hormones. The end result being low oestrogen levels. Now the reason this happens is because your brain deems your body as being unable to support a pregnancy at this time.

Why is that important?

Beyond reproductive function, periods provide good insight into the health of your bones. This is because they share a key hormone, oestrogen. Oestrogen’s role in bone health is to both slow down breakdown of bone tissue and stimulate new growth. Now we know that oestrogen is low in hypothalamic amenorrhea, therefore we also know the risk of bone damage extending to osteopenia and osteoporosis is heightened in hypothalamic amenorrhea. If you’ve had hypothalamic amenorrhea for some time, you may have been recommended to get a DEXA which is a type of x-ray for measuring bone strength.

What causes hypothalamic amenorrhea?

Hypothalamic amenorrhea doesn’t happen overnight. We know of several factors that when left unchecked for some time, contribute to hypothalamic amenorrhea:

·      Not eating enough to match your body’s needs.

·      Restrictive eating.

·      Weight loss.

·      High intensity and endurance exercise or exercising without enough nutrition.

·      Psychological stress.

·      A combination of the above.

You do not need to be in a certain body type to experience hypothalamic amenorrhea. Hypothalamic amenorrhea is about whether you are under-nourished, over-exercised, or over-stressed.

How does nutrition and exercise affect my period?

Nutrition and exercise have a role in energy balance. Nutrition provides the energy coming into your body, and exercise is one of the functions driving energy out (now feels like a good time for reminding you that nutrition is an absolute must for exercise).

There are actually several functions that drive energy out (energy expenditure). The largest is organ function otherwise known as basal metabolic rate. This is the energy that is used by organs like the lungs, liver, heart, and brain for keeping you alive. Then you’ve got the energy needed for digestion, otherwise known as the thermic effect of food. Lastly you’ve got non-exercise activity thermogenesis which is the energy you need for everyday movement like walking around, fidgeting, or doing chores. 

When your energy balance is out of whack in that there isn’t enough energy coming in to support what’s going out (a state called low energy availability or LEA), your body makes an executive decision to direct energy towards the functions that need it most for survival. This means essential organs like the brain, heart, and lungs get priority. Reproduction, which is not essential for immediate survival, falls down the list.

So when the body detects low energy availability, the brain reduces hormone signals that are involved in reproductive function in an attempt to conserve energy. This starts in the hypothalamus where gonadotropin-releasing hormone (GnRH) production is suppressed. This causes a reduction in luteinizing hormone (LH) and follicle-stimulating hormone (FSH). With low LH and FSH, ovulation stops and oestrogen production is reduced. On the outside, this looks like missing periods.  

What can I do with nutrition and exercise to support period recovery?

1.        Eat enough and eat often:

·      Eat regularly throughout the day.

·      Increase your portion sizes.

·      Add snacks.

·      Increase carbohydrates and fats.

·      Challenge any restrictive dietary rules.

·      Eat enough to match your exercise and activity levels.

It’s really important that the changes you make are consistent over time and are big enough to cancel out any calorie deficit plus more. Before your hypothalamus turns GnRH up again, it needs to feel confident that there is enough energy consistently available.

2.        Reduce exercise:

If you’re doing lots of high intensity or endurance exercise, changing your nutrition alone might not be enough. This doesn’t mean that you have to stop exercise altogether, but it may mean that you need to take a genuine break from high intensity or endurance exercise, reduce training frequency or duration, and allow for longer rest periods.

This step can be really hard if exercise is a big part of your life, but if your body is struggling to maintain core physiological functions such as reproduction, then it might be a sign your current level of activity isn’t compatible with what your body can sustainably support right now.

Considering more gentle movement options and getting enough rest might be necessary steps in recovering your period, remembering that we don’t need to ‘earn’ rest or food.

3.        Address food rules and restrictions:

Sometimes it’s not just about calories. You might be eating regularly but still:

·      Avoiding fats.

·      Avoiding carbohydrates.

·      Opting for low-calorie versions of foods.

·      Avoiding eating out.

·      Being unable to eat spontaneously.

·      Compensating for foods that you don’t define as healthy or exercising to earn/burn food.

·      Ignoring your hunger cues.

Despite perhaps eating regularly or having a ‘normal’ sized meal or snack, all of the behaviours listed can still contribute to low energy availability. So recovering your period might mean more than adding in food generally. You may also need to actively challenge some of your eating behaviours.

4.        Check your stress:

Becoming completely stress-free is an impossible standard but dedicating some time to check on your wellbeing is important. This might look like:

·      Prioritising sleep and rest.

·      Reducing excessive exercise.

·      Finding coping strategies and self-care options that don’t put additional stress on your body.

·      Seek professional support for an eating disorder, disordered eating, anxiety, stress, or similar.

A quick word on weight gain

This is a common question, and my honest answer is that it depends.

Some might. Some might not.

It all depends on which factors are keeping your body in a state of stress and low energy availability.

There is no universal weight at which periods will become regular again. This is because we all have different needs for body fat percentage, energy and nutrition, and movement.

What I can say with confidence however, is that trying to maintain a specific weight whilst trying to recover your period often makes period recovery so much harder.

What’s the timeline on period recovery?

Again my honest answer is that it depends.

Some people will see their period return quickly, others may take several months or more. It’s not uncommon for periods to be irregular as they return either.

The most important thing to consider in terms of a timeline is that one period does not mean your hormones are back to normal functioning. It’s not a sign to pull an immediate handbrake on the changes you’ve been making either. Sustained change is key here.

Next steps

We’ve talked about how important your period is, not only for reproduction but as an indicator of overall wellbeing. Hypothalamic amenorrhea carries risk of bone damage, and it also tells us pretty loudly that your body is in need of more support.

Because hypothalamic amenorrhea is a diagnosis of exclusion, professional assessment by a GP or gynaecologist is a vital first step. And if you’re not sure what constitutes as insufficient nutrition or excessive exercise, it’s worth getting a dietitian to complete a thorough assessment of your lifestyle and dietary intake. Determining an individual’s energy balance is complex because we’re all unique, so it can be particularly hard if you’re trying to get a gauge yourself from social media or the internet.

Psychological support can also be a key part of period recovery particularly if you’ve resonated with the discussion about stress and disordered eating.

With the right support, enough nutrition, and enough rest, your body can begin to restore the right hormonal balance to get your period back.

At Restore Nutrition, I support people all across New Zealand with eating disorders, disordered eating, and complex relationships with food. And I do this without focusing on weight or diets. Browse the Restore Nutrition website to see how I might be able to help or to book an appointment.