Help! I Lost My Period.
Ally Rosen MS, RDN, CPT
The menstrual cycle should be considered a vital sign, yet it is all too common for women to lose their periods and it be completely normalized. With diet culture being more rampant than ever before, the pressure to eat less and move more continues to be pervasive. In my work as a Private Practice Registered Dietitian, I have seen many clients with disordered eating and/or excessive exercise habits, lose their periods. It’s a feeling I personally know all too well. This loss of a period for at least 3 months is called Functional Hypothalamic Amenorrhea (FHA). It has been estimated that FHA affects about 1.62 million women between the ages of 18 and 44 years in the US and 17.4 million women worldwide. With a prevalence that high, this condition is not nearly talked about enough and I can tell you from my own lived experience just how deeply misunderstood it is.
When I was 15 years old, I had anorexia nervosa and I lost my period. I had only had it for a few years but it had regulated and so when I lost it, along with 35 lbs, my mom was worried. I went to see an OBGYN who promptly put me on birth control. There was no explanation that this was functional, that this was happening because of the weight loss, the increase in exercise, the stark drop in calories. At the time, I didn’t think to question a doctor’s recommendation, especially because it gave me a “period” again. But it never addressed WHY I lost my period, it just put a bandaid on the problem and let the wound grow for another 10 years until I decided to go off birth control.
During those 10 years on birth control, I healed from my eating disorder and began studying nutrition. I also started running. I ran multiple half marathons and then progressed to a full marathon. Shortly after my third marathon, I decided to go off of birth control. Though I was not intentionally restricting my food intake and was already helping many clients with their eating disorders and sports nutrition as a Registered Dietitian, I had no period for over a year after going off the pill. The first 1-3 months off the pill, it would be considered normal for your period to lag after years of synthetic hormones. But a whole year? I knew what this was- it was FHA again. I carried a lot of shame around this because I thought that as a Dietitian, “I should know better by now!” I simply underestimated just how much extra fuel my body needed when training for a marathon. I got a stress fracture in my hip as well after marathon #3 where I decided to really push my pace, a sign that my bone density was suffering the effects of low estrogen. So, I took it upon myself to get my period back and I did just that.
I will tell you first hand just how challenging- yet equally rewarding- of a journey it was. Gaining weight in a time where the world is shrinking, going from marathon running to low intensity, low impact movement, intentionally eating more than felt intuitive, and going through what felt like a second puberty. I had pimples, and mood swings, and pop punk music was my best friend again. But I wouldn’t trade a single thing, because now I have a beautiful, terrible, lovely, painful natural period and I get to help my clients get theirs back too.
So, what is Functional Hypothalamic Amenorrhea (FHA)?
FHA is a form of missing periods that happens when your brain suppresses your reproductive hormones in response to stressors like inadequate nutrition, overexercising, losing weight, or experiencing extreme emotional or physical stress- or a combo of all of it! The hypothalamus, a part of your brain that regulates hormones, stops sending the signals needed for ovulation and a healthy menstrual cycle. As a result, estrogen drops, ovulation doesn’t happen, and your period disappears. This isn’t your body being broken, it’s actually doing exactly what it’s designed to do: conserve energy in times of perceived threat or scarcity.
Why does FHA happen?
Your body runs on energy and when your energy balance is constantly off, whether from too little food, rest, or emotional balance, it goes into survival mode. When your body is in survival mode, it believes – rightfully so – that this would NOT be an optimal time to conceive and therefore stops ovulation and thus, your period.
Here’s what often contributes to FHA:
Not eating enough (especially carbs and fats)
Too much exercise (especially cardio or high intensity, without enough rest)
Chronic stress (emotional, mental, or physical)
Low body weight or rapid weight loss
Perfectionism, control, or fear around food/exercise
You do not need to have an “underweight BMI” for this to happen to you! Plenty of people at a “normal” weight experience HA if their energy balance is off.
Why is HA not normal & what are the risks?
This is not a normal variation of the menstrual cycle, it is a protective shutdown. While it may seem somewhat nice to not have to bleed every month, it can actually be pretty dangerous over time. Estrogen is not only a fertility hormone; it regulates bones, the cardiovascular system, the brain, metabolism, and many other tissues. Without it, women lose bone density and may never fully recover peak bone mass, increasing risk of osteopenia, osteoporosis, and stress fractures at a young age. Low estrogen also negatively affects cholesterol and blood vessel function, raises long-term cardiovascular risk, contributes to anxiety, low mood, sleep disturbance and brain fog, and suppresses thyroid activity, leading to fatigue, cold intolerance, hair thinning, constipation, low libido, and a slowed metabolic rate. Over time it can impair ovulation and make future conception more difficult. The absence of a period is a sign the body is diverting resources away from long-term health to survive a perceived energy deficit, and restoring a menstrual cycle means the brain once again has enough energy and safety to turn normal physiology back on.
How do you get it back?
Simply put, you have to convince your body it’s safe again.
That means:
Eating more
Resting more
Sleeping, de-stressing, and slowing down
Letting your body change if it needs to! Weight gain may happen, and it’s often necessary- especially if you are hovering way below your body’s “set-point.”
Now, I will break down the tangible steps to actually get your period back:
PROTEIN:
We want to focus on protein at every meal and protein sources that contain fat. Our body needs fat to produce hormones properly as fat stores and releases several hormones.
Fatty fish (salmon, trout, tuna > super lean white fish or shellfish)
Beef (if ground beef > 90% fat)
Chicken thighs > Chicken Breast
If turkey, >94% - never 99%
Full eggs > egg whites
Full fat greek yogurt/ cottage cheese > non-fat/low fat
FAT:
We want to include fat sources at every meal!
Full fat greek yogurt/ cottage cheese
Fattier animal products- beef, chicken thighs, fatty fish, full eggs
Nuts: almonds, peanuts, cashews, pistachios, walnuts, pecans etc.
Nut butters: peanut butter, almond butter, cashew butter etc.
Seeds: chia, flax, hemp, pumpkin, sunflower
Oils: avocado oil, olive oil (be generous with the oil you cook with- none of the “zero calorie spray”)
Avocado
CARBS:
You need carbs at every meal- yes, EVERY meal. This includes rice, pasta, potatoes, bread, quinoa, farro, orzo, bulgur, barley, tortillas etc. Be liberal with your portions! Carbs should take up about half of your plate in HA recovery. We need real carbs (aka glucose/ glycogen storage) to signal to our brain there is enough energy in the body for ovulation, and therefore menstruation, to happen safely. So this means, no more diet/low-carb versions of things ie. keto breads, keto cereals, low-carb tortillas etc. This is a really great opportunity to unlearn our society’s nonsensical hatred against carbs!
EXERCISE TIPS:
First things first, if you want to get your period back ASAP, the less movement the better. Your body views exercise as stress so if you are able to really cut back during this time period, your body will thank you. Once you are recovered (3+ periods under your belt) you can slowly start to add it back in. Consider changing some or all of the following aspects of your exercise:
Duration (ie. cutting back from 60 min workouts to 30 min workouts)
Intensity (ie. changing from running to walking, hot yoga to regular yoga, HIIT classes to strictly strength classes)
Frequency (ie. going from 6x/week to 3 or 4x/week)
Ideally you change all- however, if you are at this point with HA, you likely have had a hard time letting go of your routine. Therefore, it might take some negotiation to see what works best for you.
In my period recovery guide, I break down these steps even further and in more detail. I also give insight on the Fertility Awareness Method (FAM). When not using birth control, this method is useful in tracking your natural cycle and ovulation in order to prevent or increase likelihood of pregnancy!
I also recommend working one on one with a dietitian in this process as it can be a super daunting journey to embark on. I would love to chat with you if you think you are struggling with FHA!
Book with me here!
