Amenorrhea

Last week I was diagnosed with hypothalamic amenorrhea, and I wanted to share my journey so far. (DISCLAIMER - I am not a doctor, don't use my story as a way to self-diagnose! A lot of this info is based on my own personal research. If you think you might have hypothalmic amenorrhea, please seek guidance from a medical professional!)

My Past: I discovered weight lifting over two years ago, and like most things in my life, I went 110% full speed ahead. I loved it! I love being strong, pushing myself, overcoming, being challenged, the relaxation that the gym offers, everything about it. For over two years I've been at the gym 5-6 days per week (1 - 1.5 hours/day), every week. I wanted to excel, and I did! I went from a willowy girl, averaging about 122lbs ^55kg at 5' 8" ^173cm to a strong, powerful woman. I've done two bulking and cutting cycles (145 back to 135lbs twice). This summer I was 135lbs ^61kg, and from all my best estimates (and based off a DEXA scan from last year), definitely sub 20% body fat. I looked really good in a bikini! For over the past year I've weighed and tracked every macro, in an attempt to optimize my performance at the gym. My world strongly revolves around moving heavy objects, and I love it! I tested my 1RM recently and ended up getting 215/145/315 squat/bench/ (98/66/143kg).

Currently: Four months ago I decided to go off my birth control pills, since my husband and I want to get pregnant. You may have seen one or two posts about me lamenting my lack of period over that time frame. Spoiler alert: it didn't come back. After three months of no period, I started researching and became pretty convinced I might have hypothalamic amenorrhea. Last week, my OBGYN confirmed my thoughts, and said she felt that was probably the case. I had a hormone panel done, and the results were in line with that diagnosis.

What's Hypothalmic Amenorrhea (HA)? It's caused by any combination of three things, which are all basically summed up as bodily stress.

• Under-fueling. Being in a negative, energy balance state.

• Over-exercising.

• Stress - mental, physical, emotional, etc

Any combination of these can lead to HA. This is why it's seen in anorexics who don't work out, as well as high level athletes who have a healthy relationship with food, or even someone who just works out some, under eats a little, and has a stressful job. It's any combo.

The hypothalamus controls the menstrual cycle, and can essentially shut things down. It lowers all of the reproductive hormone production in the body, and halts the menstrual cycle since the body isn't in an optimal or safe spot to reproduce. There's a cascade of negative side effects from HA that I don't want to delve into, but you can look them up (osteoporosis is a big one). So even if you didn't want to get pregnant, having a regular menstrual cycle is very important for your health.

Now see, I knew about HA. I thought it would never be me. HA was for bodybuilders who got insanely shredded, or women with eating disorders, or marathon runners. None of those were me, so I was safe, right? I viewed food as fuel, and focused on optimizing my macros, and only ate in a deficit when I cut for summer. Plus, I was much heavier than I was before I found lifting. So HA never crossed my mind!

Well, I was wrong. And the more I looked at my life style with a new perspective, the more I realized I fit the HA profile. I worked out hard 5-6 days per week, for 60-90min per day. On top of that I also did hot yoga a few times per week, I made sure I got 10K+ steps per day, I restricted calories this past spring to get shredded for summer (I figured it'd be my last chance before kids), I minimized my fat intake probably lower than I should have in order to eat more carbs "for performance sake." I wasn't an athlete, but I was athletic.

Opinion time: I think HA is probably more common than people realize. First off, if you're on hormonal birth control, you can't know if you have HA. The bleeds you get while on birth control do not indicate if you are ovulating or not. And if you weren't on BC, and did know you have HA, it's reasonable to not tell anyone about it.

What Now? Healing HA - So this is the sucky part. The throw my world for a loop and cry in the shower part. The recommendation is: No more lifting and gain weight until I have three normal cycles (not a lean bulk, but truly just put on some body fat ASAP). I've read the research, I've seen the studies, I've read all the testimonials of women who have gone through this. I know this is the right path, but man, it's awful. I haven't been to the gym in almost two weeks (and I had cut down quite a bit for the month prior to that).

Basically, my body needs to have more body fat to signal to my hypothalamus that it's okay to menstruate. My hormone levels need to come up. My body needs to have lowered cortisol. My body needs to heal, and not be in a state of stress. Walking and yoga are allowed, but no lifting, running, HIIT, or anything along those lines (research has shown it's possible to re-gain your period while continuing to exercise. However, based on those studies, it has a much lower success rate of getting your period back, and even if you do, it takes longer than if you were to not exercise).

I know that not lifting is just for a season (until I have three normal periods), but it seems so indefinite. The general consensus is that it takes about 3 - 6 months to regain your first cycle once you commit to recovery. So that could be a long time before I'm back to lifting (and I'm hoping to get pregnant, which also means less lifting, and ugh, it's not fun to think about.)

Currently: I've ditched the scale, but from my doctor appointment last week I was 147lbs ^67kg. I probably still need to gain more. The recommendation is to eat a minimum of 2,500 cals per day in recovery, but don't cap yourself. I've stopped tracking, but have a really good handle on macros, so I know I'm eating well over that every day. The weight gain really messes with my head. I've always had a good body image, but gaining weight is rough.

The hardest part is leaving the gym though! Lifting became part of my identity. I know this is "just a season", but UGH. I feel like a fraud even being on this subreddit anymore. I miss my gym family, I miss the regulars and the workers. I miss being "the fitness person" to my friends and family. I feel like I'm giving up what I've worked so hard for, losing my identity, and seeing my body change all it once. It's an emotional roller coaster to say the least.

I've only told a few people about my HA, but one person was like, "So you're just going to quit and get fat and flabby?", cue crying in the shower. I also HIGHLY regret not doing a powerlifting meet. I wanted to, but kept pushing it off. So please, if you are thinking about doing one, just do it!

Good Things So Far:

• I have a lot more free time to spend my with husband (but dang, give me some hobby suggestions)

• Libido is back! Woo!

• I'm not hungry all the time!

• I'm happier (I was a grouch this summer, I hate to admit it)

• I have cervical mucus again (TMI? Sorry.)

• My hormones are not insanely low, which means my cycle should come back relatively soon

TL/DR - Got shredded. Lost period. Need to gain weight and stop lifting to get it back. Both of those things suck, hard. I don't feel like I belong anymore. I'm on the path to recovery, but I don't know when I'll get my cycle back. Six pack might not have been worth it.

Feel free to ask my ANY questions! I'm an open book. However, I am not a doctor! I can't help diagnose or anything like that. I just wanted to share my own personal experience with HA.

I have no idea why I posted about this. Bring awareness? Get sympathy? Just to vent? Help someone else? All of the above? I'm hoping something positive can come from this journey though!

I highly, HIGHLY recommend the book, By Dr. Nicola Rinaldi for anyone else wanting to know more about HA! She also has a bomb, awesome Facebook support group for people who have or had HA.

The recent post on amenorrhea motivated me to finally ask — I have always wondered how most of us would even tell if we had amenorrhea. Nearly every woman I know is on hormonal birth control (where monthly bleeding is triggered by the bc withdrawal - NOT the same as a period and would still happen w amenorrhea, is my understanding) or has an IUD, many of which stop periods completely.

Given that it is apparently quite unhealthy and common among runners, how would one even know whether they are at this point?

Edit: What an amazing community, these replies are all so thoughtful and interesting! Thank you!!

I saw some other posts about Mugwort and how it will bring on your cycle, and wanted to throw my story up here. I have long term Amenorrhea with zero underlying causes found after every lab, imaging and panel known to man done. Pretty much all I get from doctors at this point is "Do you want birth control?" and when declining they ask me why I'm even there. The amenorrhea has escalated since getting a little older (37) and after having kids, but now I get doctors telling me I'm in Peri since that's an easy answer. Anyways, I just spent the last almost two years without a period. I have felt like I am slowly dying and just all around terrible. Six months into no period, I started going down the path of alternatives and nothing has worked and I have tried pretty much everything. Until I finally tried Mugwort last month. It was almost immediate and it was glorious. I felt 10 years younger the last month. I was hoping it had jump started something but here at day 45 of month two I finally gave up and drank another cup of Mugwort and it happened again. I am just shocked honestly. It is just life-changing and I can't thank all the people of this board enough who post these things. The mugwort is so disgusting, but what works really well for me after some trial and error is steeping it with another HEAVILY flavored tea and then adding honey. It's tolerable after doing that!

Unsure how many female athletes there are here who’ll respond. But I’m posting anyway just in case. Spent the last few weeks searching online and various subs. I suspect this is a lot more common than is talked about.

I’ve been searching up and down on Reddit for personal accounts of what I’m currently struggling with. I’m a jj athlete who’s menstrual cycle has become very delayed. Im eating enough calories. I think. Definitely not losing weight.

Just want to know if any other women are or have gone through this. And if so would you mind sharing:

1. How frequently and intensely were you training when you noticed these changes?

2. Were you on a strict diet or eating normally?

3. When did your cycle return to its regular pattern?

4. Did you make any adjustments like reducing training, increasing rest, upping your calorie intake, or trying other methods to regulate your nervous system?

Your experiences could be invaluable to others going through similar situations. Thanks in advance for sharing!

(Yes I know go see a Dr. I’m looking for personal accounts and comraderie here)

Also feel free to DM me if you don’t want to discuss this sort of thing publicly

Hi, I just wanted to share my story here in case it might be helpful for anybody. I received lots of encouragement from this community, and now I want to share my amenorrhea journey.

I was on birth control pills for almost 5 year. I decided to quit because I learned more about the side effects of the pill and wanted to be free of any synthetic hormones. I quit the pill in February 2021 when I had my last period on the pill.

I must say that I started following a fitness program to have a leaner body about 1 year before quitting the pill. I worked out every day (2 times a day on most days) and I aimed a calorie deficient diet to maintain at least 500 calories less than what I was burning in a day. I lost about 7kg (15 lbs), and I continued like that for over a year (even after I quit the pill).

After quitting the pill, I also got a copper IUD installed to prevent pregnancy without realizing it might cause copper toxicity. I later got the copper IUD out in October 2021 (8 months after quitting the pill and not having a single period).

I didn’t care about not having periods until I started developing horrible acne on my face (around my chin and mouth). It started in June 2021 and got worse in September 2021. The acne kept getting worse until February 2022. At the same time, I realized my hair stopped growing since I quit the pill. Both the acne and hair damage hit me really hard, and I decided to do research and figure out how I can get my period back and hormones balanced. I visited multiple OBGYNs, but they all wanted to put me back on synthetic hormones which would definitely not kick start my menstrual cycle because they are just external hormones and mimic the behavior of my natural hormones and cause withdrawal bleeds as opposed to causing an ovulation and a real period. I started learning more about how diet can impact hormones and decided to work with a nutritionist. That did not go well either as my nutritionist made me try all kinds of food that I hate and asked me to remove a lot of food out of my diet like gluten, dairy, etc. (I was already not consuming much dairy as I was lactose intolerant, which is something my body developed oped lactose intolerance on the pill). Before starting to work with the nutritionist, I was still doing a calorie deficit which was already bad for my mental health as I was keeping track of everything I eat and counting all macros. With the new diet restrictions and suggestions, my mental health degraded so bad that I was super stressed about what I’m eating and not eating that it alone would make me lose my menstrual cycle and cause break outs. I finally broke free of the nutritionist and also loosened up my strict diet and work out routine.

In January 2022, I visited my primary care physician for my acne. She prescribed me with tretinoin, clindamycin and benzoyl peroxide. Benzoyl peroxide irritated my skin so bad that my face was burning and it was painful. I only kept tretinoin in my routine and it’s been very useful for my acne scars so far.

I decided to give acupuncture a chance in February 2022! I started going for acupuncture therapies immediately twice a week and they also provided me with herbal supplements both for acne and menstrual cycle. I also stopped working out so hard (in fact, I totally stopped) and counting calories. I’ve increased my food intake and I gained all 15 lbs back (and maybe more because I’m not weighing myself anymore). I can’t fit to any my clothes from last year, but I really don’t care because I just want to be healthy.

Finally, I had my first real period in April 2022!!! I felt so happy. I continued going to my acupuncture place twice a week to this day. I had my second period 40 days later. So far I had 4 periods with an average of 38 days in between periods. Even though it looks like a long period, I’m so happy that I’m ovulating and having a period. My cycles before the pill were also long (30-40 days).

My acne also started improving since I started acupuncture, but I still have some bad break outs time to time. My current routine is like cleansing twice a day and following up with tretinoin and azaleic acid + moisturizer in the pm and with vit c + moisturizer + sunscreen in the am. So, if you have any suggestions in this area, I’d be very glad to hear them :)

My hair started growing again and I can see new baby hair coming out. Also, any suggestions here would be welcomed as well :)

I am now starting to work out again but with very small baby steps and low impact work outs like walking and yoga/pilates.

Anyways, this is a long but hopefully a useful post for someone. Please let me know if you have any questions and also feel free message me privately.

Edit: forgot to mention that my iron levels were lower than the threshold (12 ng/ml back in January) and I’m taking iron supplements daily to bring it up to an optimized value (70-80).

I've been doing a gradual recomp for the last three years and am down to probably the last 10 pounds of fat loss (although I'm also happy with how I look now, so the last 10 is more of a stretch goal/interesting challenge), but I recently realized that my menstrual cycle has gotten significantly shorter, possibly due to not eating enough for the (admittedly considerable) amount of exercise I do (Don't worry, mods, I'm not asking for medical advice.).

So now I'm eating more and trying to get a more accurate sense of my TDEE, but I really didn't think I was cutting much to begin with so I'm confused about how other women, bodybuilders and such, manage to cut or stay at a significant deficit without screwing up their menstrual cycle. I've recently been learning about how hormones affect muscle gain, weight loss, etc, so I'm wondering if there are strategies or cycles to utilize that make it safer to cut? Or is amenorrhea a lot more common than I thought and people just aren't talking about it?

Hello!

I am a 21 yo female who has been diagnosed with hypothalamic amenorrhea since about age 16. I first got my "period" when I was 13, and then never again naturally had a period or ovulated. I have been to countless doctors and specialists about this problem - I have a uterus, healthy eggs, healthy ovaries, my anatomy is all normal, but I have low estrogen levels that have never been normal. I've had low estrogen ever since I was about 15, and I've been slowly investigating this problem ever since with no answers. I recently went to a reproductive endocrinologist/OBGYN who thinks that my competitive dancing from ages 9-11 "turned off" my hypothalamus and it just never turned on again. He stated that it now has a naturally low set point, so my body assumes that low estrogen production is okay. No suspicion of a pituitary tumor ever.

I have a very normal BMI of 21.6, I do not exercise vigorously and never really have (I'm on a hip hop dance team and have practice 1 hr, 2 days a week - I am still pretty fit overall), and eat intuitively and have never had an eating disorder. In terms of stress, I am pretty type A and do put a lot of pressure on myself with school, but I have had long periods of low/no stress and still no period. I have taken BC for about 3 years inconsistently as different doctors tell me different things. I've been told that I will just need to take combined BC for the rest of my life to supply estrogen to my body in normal levels. I have no other symptoms of low estrogen - I look very normal, fit, no excess body hair, no acne, no low libido or vaginal dryness, etc. On this current BC, I rarely bleed during the placebo week, but was told that as long as I bleed 2x per yr it's ok.

I try not to think about my problem too much, but when I do, it makes me extremely sad. Deep down, I have never truly felt "womanly" and am worried I never will. Unconsciously I compare myself to other girls my age and in a strange way am jealous of anyone with a normal cycle who can be so in tune with their body and know when they are ovulating. Having a family in the future (late 20's) is something that is extremely important to me, and although doctors have said that they can kickstart ovulation with a pill, I know that the absence of periods for this long is not normal and not healthy. I just want to feel normal, and I don't seem to have the typical case of HA caused by under-eating, over-exercise, and high stress. It is definitely scary. Any advice at all is appreciated. I know people suggest "No period now what," but this book is targeted at women with low BMI, under-eating, and intense exercise regimens. At this point I feel like a case study.

32F, mom of a 1 and 2 year old. I picked up running again in Sept 2021 and got serious about a base building plan in order to run my first half in April 2022. I'm in the last week of Hal Higdons base building regiment - running 3 miles 3x per week (I've made two of these speed workouts that are not prescribed but feel good anyway), a long run anywhere from 3-6 miles Saturday, and 30 min walking on Sundays which is usually 1-2 miles depending on trail/road/hills/if I have the stroller, etc. What I'm driving at - this is not exorbitant, over the top, or super strenuous training. Moreover, I've only gone from 170 lbs --> 165 lbs, but I don't really care about the scale. I've lost 2 pant sizes and I feel better and stronger, physically and especially mentally, if not a bit tired and cold all the time (northeast winters 🥶).

I am now on day 50 of this cycle, meaning I am about 20 days late for my period. I'm not nursing, absolutely not pregnant, I'm eating enough (I think, I really just eat til I'm satiated), I take a multi vitamin everyday that has iron (and I eat red meat about 2x per week, plus leafy greens). So... Really the only thing that has changed is my exercise load. I don't think I am doing nearly enough to cause amenorrhea, but I am curious about others experiences. So! Has anyone dealt with this? What was your training like when this occurred and how long did it last?

PS - I have an appointment with my doctor coming up... In April. There was nothing sooner unfortunately so I can't do thyroid/hormonal testing for a few more months.

I’m so excited to meet my new nephew in just a week but I also know it’s going to sting. I went off BC 4 months ago and I’ve only had 3 very light, watery/spotting periods and no sign of ovulation despite tracking. My OBGYN seemed so confident last month that my period would be back in no time and I’d probably even be pregnant by our next appointment in December. I can’t help but feel like that’s just not going to happen. I was on hormonal BC for 10 years. Since going off of if I get very very painful achey breasts every once in a while, but nothing else has come of this :( I’m trying not to be negative but I worry that this won’t be temporary. I really wish it were!

I began seriously running at the beginning of the pandemic lockdown, circa spring 2020. A good number of my family members and close friends are runners, so I have always been exposed to a runner's lifestyle. My goal was to run a half marathon that summer (or whenever races opened up), and I crafted a training plan accordingly. About a month into training, I lost my period. Unfortunately, my family also has a history of disordered eating, and this prevented me from recognizing hypothalamic amenorrhea as a problem. I saw weight loss as inherently good. As time passed, my training became more intense, and my diet failed to accommodate. In a series of unfortunate events, I ended up being forced out of college that fall semester in order to go to in-patient eating disorder treatment. Regardless of pure intent, my controlling and obsessive personality resulted in nearly killing myself for the sake of preserving this lifestyle of intense running and insufficient nutrition.

Although my primary focus has never been on weight, I did have a diagnosable eating disorder in the sense of uncontrollable food aversions and intrusive thoughts. It was focused on maintaining "health" (orthorexia). After two months of treatment and "refeeding," and a year of greatly reduced running and exercise, I still have not regained my period. I truthfully am in a great place mentally, much removed from where I started. Furthermore, I do understand the many errors that led me down a dark hole, and I am committed to not recommitting them.

I have since completed two semesters of college and have reintegrated exercise back into my life without treatment or any mental health related incident. My eating habits are very normal, and I do not intentionally restrict at all. However, I still have not started menstruating. I love running out of the purest intent and want so badly to get back on track training for a half marathon. My aunt is running one in June that I am invited to join! I am just concerned about the long-term consequences of hypothalamic amenorrhea, as well as the potential dangers of training when I am not starting from a point of perfect health. I have genuinely tried to get my period back to no avail, and I do not understand how distance runners are able to menstruate normally.

What is your advice on this situation? Is there a way I can safely start training for a half this summer? Does anyone have similar experiences with a success story? Can my period come back while I am running regularly?

Hi everyone Little back story. Ive always worked out either cardio or weights a few times a week for years on my own. Never followed a plan or diet just did my own thing Fast forward to last January I decided I'd hire an online coach who basically does bikini prep for women. With no intention of going on stage ever I decided I'd do his program for me and see what kind of results we could yield. I'm 37 years old, 2 kids who are at an age that I have more flexibility for my own interests so I decided to go for it. My coach is super knowledgeable and very client oriented so nothing bad against him My start weight was 141. Had good muscle mass but lots of body fat to lose. I ended up doing a cut for almost 7 months. Weight training 5 days a week and cardio almost daily at end as well. My weight was lowest at 119 at end of my cut. Problem is at around the 126 lb mark or so I lost my period. He said it was common with femals who compete and would return when we reverse etc. I've now been reverse dieting for 3 months, weight is almost up to 130. I'm still training 5 days a week, less cardio and more food. Physically I feel stronger and overall much healthier but my period still hasn't returned. Anyone have similar stories they could share? When their HA resolved? Part of me thinks I'm still under fuelling and over exercising but I'm not totally sure. My gyno says it's not HA because I've always been at a healthy weight but I disagree with his assessment. His suggestion is to go on BC to regulate but I feel like that's just putting a bandage on my problem

Hi all. My eating disorder started when I was 14 and am 35 now. Was healthy for a solid 10+ years and probably like many, covid-related stress caused a relapse. I was an athlete growing up in weight-conscious sports and then did college track. During all that time, I managed to keep my period for the most part.

However now, over the past 1 year, my period has gotten irregular, and I’ve had 2 stress fractures. I’m not restricting excessively and truly not doing a high volume of exercise, but am technically underweight and recently found out my body fat % is pretty low.

I felt alarmed when the trainer showed me that number because in my gut I knew it was dangerous. He was praising me telling me I’m doing great and look great which just made me feel like garbage. (Should I let him know I’m dealing with some “eating issues” ?)

I’m scared now that the stress fractures may be linked to losing my period. I eat virtually no meat.

I’m taking iron, magnesium, vitamin D, Omega 3, zinc, and B-complex. I’m reading that increasing dietary fat might help with estrogen. I’m being realistic that in the short term, a meaningful increase in calories Isn’t going to happen, but wondering what positive things I can do for myself while I considering working towards that.

I’ve shared bits and pieces here, and on other subs, but am posting this as a standalone now at the of , so it can be added to the Wiki.

For those who found your way to this sub due to amenorrhea, here’s what I’ve learned after my experience with it.

Is amenorrhea a diagnosis?

In short, no. Amenorrhea, or the absence of menstruation during the reproductive years, is a symptom of an underlying condition. Amenorrhea is typically defined as going three months or more in a row without a period.

Primary amenorrhea is when women fail to menstruate after reaching puberty. Secondary amenorrhea is when menstruation stops after a woman’s cycle has been established, but before menopause. For the purposes of this sub, everything in this post will concern secondary amenorrhea.

What causes secondary amenorrhea?

When it comes to amenorrhea, there are two likely causes—structural and hormonal.

The main structural cause of secondary amenorrhea is scarring. Uterine scarring or Asherman’s syndrome is the formation of scar tissue in the uterine cavity due to trauma—usually surgery like a D&C. Scarring can also form after an infection, but this is less common. Another less common cause is cervical stenosis.

The thing to keep in mind with structural causes of secondary amenorrhea is that it’s very likely you’re still cycling—you’re just not shedding any lining (i.e. ovulating but not getting a period). This can result in cyclical, period-like pain with no bleeding.

The root of most hormonal causes of amenorrhea is the hypothalamus, which controls reproduction. In short, when your hypothalamus senses it’s not a good time to reproduce, it stops sending signals to produce the hormones that trigger menstruation.

Common hormonal conditions that cause amenorrhea include: **hypothalamic amenorrhea (HA), lactational amenorrhea (LA), hyperthyroidism, hypothyroidism and Polycystic Ovarian Syndrome (PCOS), and among others.

What can I do if I have amenorrhea?

The first thing to do is work with a doctor to find the root cause of your amenorrhea.

Your OB will probably recommend going on hormonal birth control to “regulate” your cycle, but we’re all here because we’re trying to get pregnant, so that’s a non-starter. Plus, hormonal birth control doesn’t regulate your cycle, it just provides your body with artificial hormones that suppress ovulation and give you a withdrawal bleed every few weeks. Hormonal birth control can never “fix” your cycle, it just masks problems that are still there. I’ll get off my soapbox now.

Your best bet is to find an OB that will do a full hormonal blood panel or head straight to an RE. In my experience, REs are much better equipped to diagnose the cause of amenorrhea—particularly those that aren’t solely focused on treating infertility.

Now this isn’t your standard CD3 bloodwork because without a cycle you don’t know when CD3 is. So you can have blood drawn at any time, but you’ll want to make sure they check the following:

Follicle Stimulating Hormone (FSH), Luteinizing, Hormone (LH), Estradiol (E2), Thyroid Stimulating Hormone (TSH), Testosterone, DHEA-Sulfate, Prolactin, Sex Hormone Binding Globulin (SHBG)

And you can throw these in for good measure: Free T3, Free T4, Progesterone

Once your doctor has your blood panel results, they can decide to do further diagnostic tests in order to pinpoint the cause of your amenorrhea.

If they suspect a structural issue, you may be asked to take 7–10 days of hormonal birth control, then stop and see if you get a withdrawal bleed. Getting a withdrawal bleed is a good sign that you don’t have scarring, but it isn’t definitive. Whether or not a bleed occurs, you’ll then want to get a saline sonogram to look for scarring. A hysteroscopy can also be used to look for scarring, but its more invasive, so I would—and did—opt for the saline sonogram first.

If they suspect a hormonal issue, they might take one of two routes. First is a 10-day Provera challenge to try and induce a withdrawal bleed. You do not have to do this if you don’t want to. Instead of going straight to Provera, you can opt for an ultrasound to check the thickness of your lining and count the follicles in your ovaries. I personally prefer this method because it can help diagnose PCOS and HA, whereas the Provera challenge is really only necessary if your trying to diagnose HA.

I had regular cycles before, but my doctor says I have PCOS. What’s up with that?

If your doctor takes a broad view of the diagnostic criteria, it’s really, really easy to confuse HA for PCOS. For an in-depth analysis of HA versus PCOS .

My doctor says I have HA. What can I do about that?

While the causes of HA are simple—some combination of under-fueling, over-exercising, and stress—the solution can be complex as it involves lifestyle and mindset changes. The best resource to start with is . There’s also the and podcasts.

Also from :

>Just wanted to add that HA can also be caused by pituitary tumors such as prolactinomas - they’re relatively rare but easy to treat. If you have one if these, lifestyle changes will likely not help you, but there are medications that can lower prolactin levels, and generally your cycle will return once that happens. They do require contrast MRI to diagnose though.

>For secondary infertility, it’s easy to miss a prolactinoma thinking it’s lactational amenorrhea.

I’m still breastfeeding my toddler and don’t have a cycle. Is this still LA?

This is a tricky one. Most women will have resumed cycling by 12 months postpartum even if they’re breastfeeding. If your child is 15-18 months old or more and you still don’t have a cycle, it’s a good idea to see your doctor and request the blood work described above.

It’s totally possible that breastfeeding is what’s keeping your cycle away, but it’s also possible that what your doctor thinks is LA is actually HA, PCOS, a thyroid issue, Sheehan’s syndrome or a prolactinoma.

It may not be possible to distinguish between HA and LA with your bloodwork, but you can try following the protocols in before weaning if your goal is to regain your cycle while still breastfeeding.

Note: I tried this approach with mixed success. While I almost ovulated and got a breakthrough bleed while still breastfeeding, I ultimately decided to fully wean my son in order to try and get my cycle back more quickly. Basically, your mileage may vary.

Things like PCOS or a thyroid issue should be more apparent, but it’s important that you advocate for yourself because, in my experience, most OBs want to chalk everything up to breastfeeding and getting care means “being Scarlett” as my mother likes to say.

If you’ve read this far, I just wanted to say that if you feel stressed, sad or mad about your amenorrhea, it’s okay. Having a healthy, regular menstrual cycle is important for more than just reproduction. If you’d like to learn more about that, definitely check out and pretty much any episode of the podcast.

Hi everyone, I want to share my story to see if anyone has had a similar experience as mine. I stopped taking HBC back in December 2019 and have not had a natural period since. When I went to my gyno in June 2020 all of my hormones were really low and I failed the provera challenge. At the time I was running alot and eating a pretty strict plant based diet.

I've made some life style changes and gained some weight and was diagnosed by an endocrinologist in October 2020 with phenotype D PCOS because of anovulation and cysts on my ovaries. I did not have high androgens and my LH and FSH at the time was 1:1 but I had high AMH.

I think maybe I had HA but have since recovered but now I'm not sure if I'm just dealing with lean PCOS or my body still hasn't rebounded from birth control and HA. I'm constantly torn between trying to treat myself for HA vs PCOS which are like polar opposites. I'm currently taking letrozole because I'm TTC so I'm still trying to avoid HIIT and running but I'm dying to workout hard.

Anyone else experience anything like this?

It was suggested that I repost this here, looking for advice.

Hi all,

Has anyone had hypothalamic amenorrhea and had much success with conception? I have had advice on how to regain my period (I know what the likely cause of the loss of my period is), but I was curious on whether having lost your period for a significant amount of time over your twenties caused much difficulty for you when TTC even when your period came back and what I might be in store for, so I can plan accordingly. I am 27, and have had period loss for 5 months this time around, I got it back unpredictably 3 times before that, before that it was gone for a few years, before that I had it for a few months again and before that it was gone on and off for a few years.

Thank you.

First, a disclaimer: I am not a healthcare professional. Please don't diagnose yourself with anything based off this post. If anything you read concerns you, then I would recommend seeking a doctor's opinion.

This is , so a lot of users here are going to have something in common (beyond the whole fitness thing): a menstrual cycle. There's been some discussions recently about training around your cycle, but not a lot on What To Do When Things Go Wrong. Based on my own experience, though, and what I've seen on social media, I think diet/exercise-related amenorrhea is a topic that deserves more awareness.

What is amenorrhea and why should I be concerned?

In the literature, secondary amenorrhea is defined as three or more missed periods in a row. Oligomenorrhea is <9 periods in a year (i.e. an irregular or excessively long menstrual cycle). Both criteria are for women who were previously menstruating regularly. Primary amenorrhea is the absence of a menstrual cycle in girls aged 15 or over (i.e. never getting your period).

Missing your period might not seem like a big deal, especially if you're not planning on getting pregnant. But depending on the cause, it's most likely a sign that your hormone levels aren't where they should be, and that has serious health consequences. Having low estrogen negatively affects your bone density, mood regulation, and ability to build muscle.

Why is this on a fitness subreddit?

Several non-lifestyle conditions can cause amenorrhea: thyroid dysfunction, pituitary tumours, and PCOS. These should all be tested for if you're experiencing amenorrhea. Dr Nicola Rinaldi, who's basically the period lady of the internet, has a good resource sheet on HA vs. PCOS and one on amenorrhea in general .

But your lifestyle choices can also lead to amenorrhea. As briefly as possible, the risk factors are:

• eating habits (not only what and how much, but also when)

• weight and weight loss

• exercise habits (including fueling before/after, frequency, type, and intensity)

• stress

The personal story bit, or 'why you don't have to be an athlete/have an eating disorder to lose your period'

There's a common misconception that only very lean women, serious athletes, or women with eating disorders lose their periods. That's not the case. The hypothalamus, which regulates your hormone levels, is pretty damn sensitive to energy availability and cortisol levels. If your body is under stress or in a state of low energy availability you can develop hypothalamic amenorrhea regardless of weight or exercise habits. Some women develop amenorrhea eating 1200 calories a day and doing HIIT 5x a week. Others develop it eating 2000 calories a day and lifting 3x a week. There is no 'type' for HA, and you shouldn't brush it off as something that will never happen to you.

When I first missed my period, I ignored it. After the second missing one in a row I did some googling. I read a few webpages, evaluated my own eating and exercise habits (small deficit, ~5lbs weightloss over two months, running 3x a week plus social sports 1x a week) and promptly dismissed HA as a potential diagnosis. In reality, I was going through a stressful period in my life, inadvertently eating a low-fat diet, and consuming the majority of my calories in the evening (so spending a lot of the day in a state of low energy availability). I can't for sure say that's what caused me to lose my period, but I wish I'd considered it so I could have fixed the situation faster.

I'm on hormonal birth control, this doesn't apply to me/I have a period, this doesn't apply to me

Estrogen-based hormonal birth control induces a period regardless of your other hormone levels. You can be menstruating on BC and still underfueling/underrecovering, which will reduce your ability to build muscle, recover quickly and consequently adapt to your training.

Amenorrhea is closely related to Relative Energy Deficiency in Sports, or RED-S. Other symptoms include:

• Overtraining or difficulties taking rest days

• Recurrent injuries, including stress fractures

• Frequently feeling cold

• Disrupted sleep patterns

• Constipation, bloating, and other digestive issues

• Fear of food and weight gain

• Anxiety around meals and irrational behavior

• Poor performance and difficulty adapting to increased training

• Increased fatigue

• Very low or high resting heart rate

Even if you have a period, if you think you might have RED-S, you should seek professional help.

What can I do to reduce my chances of amenorrhea?

• Eat sufficient calories to match your energy output, including all major food groups. Ensure you're eating adequate carbohydrates and fats; endurance athletes require a higher carbohydrate intake than the general population, and women have a higher minimum fat intake than men.

• Avoid extended periods of low energy availability - e.g. by refuelling after workouts

• Avoid or limit fasted training - no more than twice a week, for <60 minutes, at a low intensity (according to Renee McGregor)

• Limit HIIT - true HIIT should be done no more than twice a week to allow sufficient recovery

• Reduce stress levels - nutrition and training will play a part here, but as well as eating enough/taking rest days it's worth trying to destress. Find a non-fitnessy hobby! Read a book! Make something! Volunteer!

What's recommended for amenorrhea recovery?

Individual plans will differ depending on your background. The general consensus (McGregor, Rinaldi, etc) is to change your food and exercise habits. Most women will need to overall eat more; others may simply need to adjust nutrition timing or carbohydrate/fat intake. Similarly, most women will need to overall exercise less; others may reduce intensity, type, or duration of exercise.

Dr Nicola Rinaldi's approach to HA recovery, popularised as 'all-in' recovery, sets a daily calorie minimum of 2500 (2300 for very short women) and advocates going cold-turkey on all exercise (except very light yoga, stretching, etc). Stephanie Buttermore, this subreddit's marmite influencer, popularised it in her recovery from extreme hunger. Renee McGregor takes a more moderate approach, instead recommending exercise reduction and personalised changes to nutrition.

Amenorrhea can have a mental, as well as physical, component. If you struggle with guilt over food or exercise, or would be distressed if you had to change your food and exercise habits, please focus on improving your relationship with food and exercise as well. (I'm going to be totally upfront - the idea of doing NO EXERCISE WHATSOEVER terrified me, and I'm not even a gym junkie kind of person. I went cold-turkey to try and beat that fear, and now I have an amazing relationship with exercise. 10/10 would recommend)

Resources

Dr Nicola Rinaldi's website,

(the mods are very strict on Rinaldi's all-in protocol, so if you plan to exercise in recovery I would avoid discussing that; some ED/exercise addiction overlap with members)

Renee McGregor's , , and Trainbrave (also on Spotify, etc)

wrote a great post on her experiences

Googling for RED-S, low energy availability, exercise addiction and orthorexia should provide relevant information for each topic. There are also many youtubers who cover HA recovery: most notable are Stephanie Buttermore's "all-in" series (she did not have HA, but she did follow a modified version of Rinaldi's protocol) and acaseofthejills (a former ultrarunner and 'healthy eater' who recovered from HA).

It was awesome while it lasted. I felt so alive and happy. No worries, no hot and cold episodes, no mood swings*. Things were consistent. It was nice not having to worry about stupid little cotton adhesives, or wings, or strings, or any other important details.

I'm sad I have my period again. I did not miss it. Can I go back to not having it? That was nice.

*Related to my period. As for pregnancy and motherhood hormones, there were plenty of mood swings, worries, and hot or cold flashes, plus bonus baby bodily fluids.

i can't even i'm genuinely crying this is worth all the weight gain. Literally just an hour ago I was freaking out about eating too much and feeling unusually hungry AND THEN THIS HAPPENS. Funny how anorexia can still manage to wiggle into my head and whisper shit BUT NOPE NOT HAPPENING.

this by no means is a reason to eat less or do any sort of restrictive behaviour just because I am now "healed", I will continue to eat whenever I feel hungry and eat as much as I want to feel satisfied.

I know one thing for sure, I will NEVER restrict food EVER EVER again. I don't care how much i weigh, I have already wasted 2 years of my teens on this nonsense, wrecked my metabolism, stalled some growth, messed up my hormones, NEVER AGAIN, NOT WORTH THE SKINNY JEANS.

Hi Ladies,
Have any of you been diagnosed with hypothalamic amenorrhea?

 
A bit of background:
In December of 2016 I went off the pill due to having changed types a few times and decided to go off and reevaluate since I had been on the pill for 11 years. A few months later, after having not been visited by AF I decided to head to the doctor, which resulted in blood work and a diagnosis of PCOS. The only thing off about my blood work was that my AMH was high and when asking if she would do an ultrasound her response was that it "wouldn't change her treatment plan". I asked about whether it could be exercise induced and she said no. I then asked her about what we should do when we want to conceive and she said we would need to have been "trying" for 6 months prior to her doing anything. Her definition of trying was BD 3-4 times a week, regardless of whether I was ovulating. All of this struck me as odd, but I just went along with things as we weren't planning on trying at the moment.  
Fast forward to July and I still have yet to have a natural AF and decide that it is time for me to do something about it. I message my doctor and let her know and she prescribes me metformin. After a few weeks of taking it (fortunately did not have a horrible experience, just some nausea), I decided it was time for me to see someone who specializes in reproductive health.  

2 Weeks ago my husband and I went to see an RE. He read through all my charts, questionnaire, etc. and was not convinced it was PCOS. He agreed that without an ultrasound, the diagnosis shouldn't have happened. He thinks it could be hypothalamic amenorrhea due to being a long distance athlete. He isn't concerned about my weight (BMI of 22), but thinks it could just be how much I was working out this summer. He did perform an ultrasound and one ovary looked like it could be slightly polycystic, though too small to actually diagnose it, and the other looked healthy and like it may have ovulated recently (as did my uterus). He also told me to stop taking metformin I go back in tomorrow to have a second ultrasound to see if things have changed in 2 weeks. He thought I may get AF before tomorrow's appointment, but so far nothing. I will learn more of what our plan is after tomorrow's appointment, but the RE was optimistic after our last one and was willing to prescribe me medication for me ovulate as soon as we were ready (our plan was to start trying right around now). After my appointment tomorrow I will update.    

Question for you all
Has anyone here been diagnosed with hypothalamic amenorrhea? If so, what is your story? Would love to hear from others about what their journey has been like.  
 
tldr: OB diagnosed PCOS, went to RE for second opinion and the thought is hypothalamic amenorrhea.

UPDATE: Well it looks like it is officially PCOS. Going in again in 3 weeks for a third ultrasound and then will start on provera and letrozole to get me to ovulate.