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Hypothalamic amenorrhea: Causes, symptoms, and how to get your period back

Updated: Apr 14

Have you lost your period and are trying to get it back or are unsure why you have lost it in the first place? If you struggle with your relationship to food and you've lost your period; you're in the right place.

In this blog we will discuss what is hypothalamic amenorrhea, what causes it, the symptoms, and how to overcome it.

What is hypothalamic amenorrhea?

Amenorrhea is the absence of period for three or more consecutive menstrual cycles. It can happen for a variety of reasons.

Hypothalamic amenorrhea is a secondary form. People who have hypothalamic amenorrhea experience a loss of a regular period. This is caused by a disruption in the normal process involving hormones between our ovaries to our hypothalamus gland.

The hypothalamus gland is the control center that controls the many functions including reproduction. It produces a hormone called gonadotropin realsing hormone. This hormone then triggers the pituatary gland another part of the brain.

The pituitary gland releases two hormone called folic stimulating hormone and lutensing hormone. These hormones signal the ovaries to produce sex hormones used in the menstrual cycle.

Hypothalamic amenorrhea is your brain telling your ovaries to slow down and reduce the production of sex hormones and ovulation. Also known as, "I can't get pregnant right now - there's too much going on."

Primary vs secondary hypothalamic amenorrhea

Primary hypothalamic amenorrhea: You have not experienced regular menstruating by the age of 17.

Secondary hypothalamic amenorrhea: You have had regular menstruation but have now lost your cycles.

What is a regular menstrual cycle?

The menstrual cycle is the time from the first day of a period to the day before the next period. The time of a menstrual cycle will vary from person to person. The average is to have a period every 28 days. It is normal for cycles to vary from 21 days to 35 days.

A healthy period should have 3-7 days of a flow followed by a few days of a lighter bleed. There should be no bleeding at any other time of your cycle.

Menstrual blood should be a red colour without the presence of blood clots or mucus. If your blood is a dark purple or brown colour this is an indication of poor uterine circulation.

Hypothalamic amenorrhea causes

There are a few factors that can cause hypothalamic amenorrhea such as over-exercising, under-nourishment and weight changes,

Eating too little

You can loose your period if you are not eating enough foods to keep your body fueled for everyday activities. This can cause you to loose weight because you are burning more calories then you are eating which will cause an imbalance.

This is common among people who have an eating disorder, dieting or who participate in high intensity sports or exercise.


There are two types of stress. Physiological is the mental stress we typically experience. Metabolic stress is the physical stress associated with higher levels of the hormone cortisol.

This could be short term or long term depending on the person, but it can get too much for our bodies and cause period loss.

Body weight

A sudden drop in body weight regardless if it was intentional or not this can cause you to lose your period. It occurs when our bodies have inadequate fuel in relation to our requirements. This causes the breakdown of fat for energy.

The body has an amount of fat to protect our reproductive organs and function, it stores vitamins and it's an extra source of energy. This can happen at any body size; it is not just women with a lower body weight.

Exercising too much

During over exercising you can develop hypothalamic amenorrhea from having an energy deficit. This is energy deprivation from not eating enough and exercising too much. It slows down your metabolism so you stop ovulating to conserve energy.

Poor sleep

Sleep deprivation suppresses melatonin production as well as excessive HPA activation which is required for stress adaptation.

Medical conditions

Medical conditions such as PCOS can contribute to losing your period, due to a deficiency in certain hormones. Birth control such as post-pill fatigue can also cause period loss.

Symptoms of hypothalamic amenorrhoea

Physical symptoms

  • Low levels of reproductive hormones. The body pauses the production of the reproductive hormones which will cause an interference with menstruation and ovulation.

  • Feeling constantly cold

  • Feeling fatigued

  • Weakened bones

  • Brittle hair and nails

  • Digestive issues

Psychological symptom

  • Feeling of anxiety or depression

  • Having a poor body image or being fixated on bodies

  • High levels of stress

Behavioural symptoms

  • Having an obsession with food and your eating patterns

  • Engaging in restrictive behaviour around food like avoiding certain food or food groups and controlling the portion sizes.

  • Over exercising and having feelings of guilt if you have a rest day or exercising when you are sick or injured.

How to start healing hypothalamic amenorrhea

1. Ensure regular eating

This includes having three meals a day and three days throughout the day.

2. Focus on eating enough food

Including catching up on lost calories from exercise. It can be hard to say what enough food is but eating adequate amounts for your daily activities like breathing, thinking, your heart beating, cleaning and cooking.

3. Focus on less intense exercise

You need to evaluate if the exercise you are doing is greater than the energy intake. If yes then reconsider if exercise is beneficial in your recovery or significantly reduce the volume and intensity of the exercising.

4. Stress relief

Find activities you enjoy that relieve your stress, like reading, cooking/baking or painting.

5. Adequate + restful sleep

Sleep is so important for our bodies, it helps our brains, keeps our emotions in check and reduces stress.

Missing your period is a tricky situation to be in. Especially if you've lost it due to under eating and/or over exercise. That's what most of our clients are struggling with.

What should you do next?

If you're ready to transform your relationship to food and recover from hypothalamic amenorrhea... We recommend getting in touch with us to book a clarity call. You can read about the private nutrition therapy support we offer to see if we're a good fit to hep you.


We are a specialist eating disorders and disordered eating online clinic. We support people with troubled relationships to food with expert Nutrition Counselling.

Founded by Shannon Western in 2019. The team has grown to welcome wonderful Dietitians and Nutritionists all to help you feel better with food.

Are you:

  • Struggling with feeling overwhelmed or out of control with eating?

  • Unsure about when, why, and how much to eat?

  • Ready to take the steps (however small!) away from your eating disorder, disordered eating, or long dieting history?

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