Why Has My Period Disappeared? An introduction to hypothalamic Amenorrhea.
Periods can be a bit of a mare. They’re messy, a faff and tampons are expensive. Premenstrual syndrome (PMS) can also cause cramps, pain or us to feel moody or irritable. Sometimes we may think life without a period would be idyllic however if you aren’t getting a period, it’s a sign your body’s reproductive system isn’t working properly, and while this may have some perceived benefits, you could really be putting yourself at risk.
Absence of Periods
There are links between lack of a period and:
Brittle bones – osteopenia and osteoporosis
Cardiac issues
Neurodegenerative diseases (Alzheimer’s and dementia)
Greater risk of premature mortality (1)
Periods can stop for a variety of reasons and is commonly referred to as amenorrhea.
Primary Amenorrhea is the absence of a period before 16.
Secondary Amenorrhea is the cessation of normal periods, usually for over 3 months in a previously menstruating individual.
Just FYI periods may disappear due to other conditions including PCOS. If you aren’t getting a regular period, I would advise speaking to the GP.
(I think it’s important to note here that not all people who menstruate are women - often trans and gender non-conforming individuals can be overlooked when talking about periods and unfortunately do not receive the proper treatment and support they need)
What is Hypothalamic Amenorrhoea?
Hypothalamic Amenorrhoea (HA) is caused by the inability of the hypothalamus area of the brain to maintain signal balance, meaning that sufficient hormones aren’t made to have a regular menstrual cycle. This can be in both primary and secondary amenorrhoea.
So, what can cause the hypothalamus to lose control of signalling? As it turns out some pretty important everyday things:
Energy deficit
Exercise - including moderate but especially high-intensity exercise
Stress (both physical and psychological)
Past or present weight loss from set point (HA can exist across the weight spectrum)
Genetics
We live in a world where excessive exercise and “healthy” eating is glamourised and where stress and lack of sleep are all too commonplace. Many of us have hectic lifestyles with multiple things to juggle all at once and there’s even a pressure to have this type of lifestyle (as though it should be worn as a badge of honour) but all this takes its toll on the body and hormone production can be shut down, stopping ovulation. Our body is able to prioritise what is essential to help us to survive during times of stress, meaning it would rather stop us having a period and focus on keeping our heart beating.
Let’s go through in turn and see how each of the above can impact on our hormones, in turn, switching off our periods.
Energy deficit
If you’re not eating enough, your brain (hypothalamus) is going to know about it, and its response is to slow down efficiency or switch things off.
You have two autonomic nervous systems. Your sympathetic nervous system (SNS) and parasympathetic nervous system (PSNS). You can think about the SNS as your “fight or flight” and your PSNS as “rest and digest” or “feed and breed”. I’ve summarised the difference below.
Basically, you have to think of your SNS as running from a Tiger, when your body needs to purely survive or run it starts switching off systems that aren’t totally essential, meaning you can’t give birth whilst running from a Tiger!
However, in our modern-day our body doesn’t know the difference between running from the tiger and running at Barry’s Boot camp or simply having to survive the day without adequate calories. A study looking at the role of disordered eating behaviours in the development of HA. They found that 48.8% of individuals with HA report disordered eating behaviours including bulimia, dieting and food preoccupation (2).
Increased caloric intake and subsequent BMI has been found to lead to a return of the menstrual cycle in numerous studies. One study found that for every single unit increase in BMI, a womxn had a 34% increased chance of their period returning (3).
Putting calories back in may not be easy for everyone. We live in a world which values slenderness and initially eating more can feel uncomfortable. It may be that you want to call in some help from a registered nutritionist or dietitian, or even a psychologist who may be able to support you best with changing attitudes towards food and body image.
Upping food intake to support your body won’t just see the return of your period. You’ll also likely have better energy levels, sleep, feel warmer, have less brittle and dry skin and bones. Our bodies are smart so with extra food our resting metabolic rate increases, we might sleep at a higher temperature or subconsciously just move a little more in the day. Personally, a smart, happy and optimally functioning body is the best way forward.
Exercise / Movement
There are many benefits of exercise for mental and physical health. I actually refer to it as joyful movement as exercise implies you have to be in lycra or in the gym for it to count. Actually, joyful movement might be a dance class, walking to work or a bit of housework when you can play good tunes.
I was also reluctant to say “excessive” exercise may cause HA because the truth is our bodies are all unique in how much exercise we can handle. For some individuals, several hard-core fitness classes a week could be enough to dysregulate the hypothalamus. In fact, multiple studies have shown that 48 to 79% of menstruating individuals who exercised 3 times per week or more had disordered menstrual cycles. These individuals were of a stable weight but their food intake was not monitored so it’s possible they were not eating optimal caloric intake (4).
Exercise can be a form of stress relief, but it’s also a form of “stress” to the body. A little stress, known as eustress can be good, but too much and we start seeing a rise in cortisol. High-intensity exercise may put more stress on the body that lower intensity training. Both cortisol and sex hormones are made from cholesterol, so when the body is stressed there is what’s called the “pregnenolone or cortisol steal” which shuts off the other pathway preventing the production of oestrogen and causing amenorrhoea.
We also live in a culture that places a huge amount of value on a lean toned aesthetic with visible muscle and little body fat. “Lean” is a buzzword and many aspire for it, however, one can be too lean and actually we need some body fat which has numerous benefits to the body – protection of key organs, warmth, and to produce certain hormones including leptin and oestrogen. The combination of lack of caloric intake and overexercising can result in too little body fat and therefore inadequate oestrogen production again resulting in amenorrhoea.
Inadequate Sleep
Lack of sleep is a significant stressor on the body and again results in that “pregnenolone or cortisol steal” and may risk amenorrhoea. Research also supports that sleep is impaired in underweight individuals.
Stress
I briefly touched on the difference between eustress and “stress” stress. The former is the kind of stress that can be beneficial and make us stronger. The latter is what can trigger excessive cortisol (stress hormone) release and may result in that “pregnenolone or cortisol steal” which shuts off the other pathway preventing the production of oestrogen and causing amenorrhoea.
Under-eating and overdoing exercise are two stressors but so are other everyday things, putting too much pressure on ourselves, feeling like we lack control etc.
It is important to note that individuals may not even be aware of the stress they’re under or feel excessively stressed, but there are lots of mental and physical stressors at play that may be having an impact on the body even things like pollution and long working hours we don’t notice or just take as a given which maybe having an impact on the body.
Summary
Lack of sleep, stress, overexercising and inadequate dietary intake are all stressors to the body. These stressors deplete the body of energy required to make hormones and send signals to the brain to stop menstruating. Addressing these things can help the hypothalamus maintain balance and allow our reproductive system and overall body to function as it should.
It may also be important to say that the oral contraceptive pill may result in no periods or give an artificial bleed. These may often mask underlying problems that may be occurring due to the factors outlined in this article. If you are experiencing amenorrhoea, or have concerns please do visit your GP and speak to them about ways you can get adequate support.
Looking to find out more, we recommend the following:
LCIE weight inclusive guide to Hypothalamic amenorrhoea
Why am I not getting my period article by The Real Life RD
References