Hypothalamic amenorrhea recovery signs you’ll want to look out for


You’ve lost your period, and now you’re on the path to recovery. Great job! Restoring your cycle is no easy task. Now you’re asking yourself “What hypothalamic amenorrhea recovery signs do I need to look out for so I know I’m on the right track?” 


As you correct energy imbalances and stabilize your hormones, your body is sure to send you signals letting you know your period will soon be on the way. To recognize the recovery signs, first we have to understand what is happening in your body when you lose your period to begin with.

What is hypothalamic amenorrhea?


Hypothalamic amenorrhea (HA) is a condition that results in an individual losing their period due to hormonal imbalance. HA is most commonly seen in women struggling with an eating disorder, but can also develop as a result of extreme stress, restricted eating, or over exercise. 


Although HA is often associated with weight loss, you do not need to have lost a significant amount of weight or be clinically underweight to lose your period. Women in larger bodies who are struggling with an eating disorder often have their missing periods overlooked because they do not “look sick enough.”

What causes hypothalamic amenorrhea?


Your menstrual period is regulated by a small gland in your brain called the hypothalamus that triggers the release of reproductive hormones. When your body is under extreme stress, the hypothalamus stops signaling the release of these hormones to stop your period in an effort to conserve energy for other “more important” organ systems, like your brain, heart, and lungs. The following can contribute to HA:


Restricted food intake/nutritional deficiencies

Inadequate intake of essential macro- and micro- nutrients, especially fats and carbohydrates, puts stress on your body and makes it difficult for your body to produce adequate hormones to support menstruation.


Excessive exercise

Exercising with increased frequency, intensity, and duration can all result in the loss of your period. Female athletes, like gymnasts, ice skaters, or runners, may experience HA as a result of over-training.


Low body fat/low body weight

Weight loss is indicative of an energy imbalance, meaning you are not consuming adequate calories to support your energy expenditure. Weight loss can put stress on your body, even if you think you “have weight to lose.” 


Chronic stress

Chronic physical, emotional, and/or mental stress can all result in the loss of your period. Although most associated with stress from over-exercising, under eating, or weight loss, HA can also be related to stress from other traumatic events.

Signs and symptoms of hypothalamic amenorrhea


The hallmark symptom of HA is the loss of your menstrual period for 3 or more months without being pregnant. Other symptoms might include:


  • Body temperature dysregulation
  • Bone loss and increased stress fractures
  • Thinning hair, dry skin, or brittle nails
  • Low energy levels and fatigue
  • Compromised immune system
  • Decreased sex drive
  • Anxiety and depression

How to recover from hypothalamic amenorrhea


Weight restoration

Restoring body weight requires more calories than you may expect or be used to. Your body’s metabolism (RMR or resting metabolic rate) will speed up quickly once you begin to re-feed it. Only eating according to hunger and fullness cues may not be enough to restore your weight. Your dietitian can help you determine how much you will need to eat to recover.


Increase caloric intake

Focus on eating high-calorie, low-volume foods that deliver a lot of energy in small amounts. Examples include eating full-fat dairy products, replacing water with juices or smoothies, and mixing in nut butter, cream cheese, butter, coconut or olive oil, or avocado into your foods. Going from under-fueling to adequately fueling might feel strange at first, so it’s important to know what to expect. When you begin to eat more, you might feel full quickly after eating even small portions. You may also experience swelling, bloating, constipation, and acid reflux which are most often temporary. 


Eat calcium-rich foods

Bone loss is a dangerous side effect of losing your menstrual period. Increase your calcium intake by eating more dairy products like milk, yogurt, and cheese. Some other sources of calcium include leafy greens like kale, seeds like sesame and chia, beans and lentils, almonds, canned salmon, and tofu.


Exercise less

It is important to scale back on the frequency and intensity of exercise, especially cardiovascular exercise. Even moderate exercise paired with inadequate energy intake, stress, and genetics can lead to amenorrhea in some women, so taking time off from the gym, team practice, and training is important. If and when you do exercise, make sure to eat before, during, and after training.


Relieve chronic stress

Your body’s reaction to high-stress levels may be affecting your ability to restore a healthy weight. By nourishing your body with adequate food and resting your body from exercise you are already lowering your body’s response to physical stressors.

Hypothalamic amenorrhea recovery signs


How do you know if you are recovering from HA? Look for these 6 signs:


1. Increased hunger signals

Feeling hungry again is a sign that your metabolism is speeding up. Eating more will help correct energy imbalances and will prompt your metabolism to work faster, leaving you feeling hungry more consistently. If you suddenly feel like a “bottomless pit” and can’t get enough to eat– that can be normal! Your body just needs a little time to catch up. Once it does, your appetite will normalize again.


2. Feeling full and satisfied after eating

Just like your hunger cues, your fullness cues re-emerging is a hypothalamic amenorrhea recovery sign as well. Nourishing your body will, over time, also lead to greater satisfaction with meals, so you won’t feel compelled to obsess over food or over eat.


3. Positive mood

Serotonin, dopamine, and other mood stabilizing neurotransmitters are negatively impacted by a drop in estrogen commonly associated with HA. A sign that your body is recovering and your hormones are normalizing is a lift in mood. You might find yourself feeling less depressed and anxious, and more able to engage in activities you once enjoyed.


4. Increased cervical mucus

Changes in your cervical mucus are normal during your menstrual cycle. However, with HA, cervical mucus can decrease and leave you feeling dry. If you’re experiencing more mucus or discharge, this could be a positive sign that your period could be soon to follow.


5. Changes in body temperature

Individuals with HA often complain of feeling cold. This is because your basal body temperature drops in an effort to conserve energy. During the course of a regular menstrual cycle, your basal body temperature changes from around 97 degrees prior to ovulation to 98.6 degrees after ovulation. Tracking your basal body temperature could provide insight into your cycle and your progress towards HA recovery.


6. Increased libido

Your sex drive is controlled by your reproductive hormones, estrogen, testosterone, and progesterone. With HA, your sex hormones decrease, as does your sex drive. If you’re feeling a little more….*excited* than usual, this could be a positive sign that your hormones are balancing and your period is on the way!

Where to find recovery support


Discuss your missing menstrual period with your primary care or your OBGYN who can help rule out other conditions that might lead to you missing your period. Then, work with a registered dietitian to determine what and how much you need to be eating to correct energy imbalances and restore a healthy body weight. Your dietitian can help you plan meals and navigate challenges with eating. If you aren’t already, consider also working with a therapist who can help you manage stress and practice healthy coping skills.

Kristin Jenkins is a dietitian nutritionist based in Maryland. She has been involved in the field of eating disorders and disordered eating for over 6 years and brings both personal and professional experience to her work serving clients who struggle with their relationship with food and their bodies.