Table of ContentsView AllTable of ContentsEating Disorders and AmenorrheaContributing FactorsPrevalenceConsequencesTreatmentWhat to DoTreatment Outlook

Table of ContentsView All

View All

Table of Contents

Eating Disorders and Amenorrhea

Contributing Factors

Prevalence

Consequences

Treatment

What to Do

Treatment Outlook

Hypothalamic amenorrhea is a common medical condition in women of childbearing age with eating disorders. The body enters survival mode, periods stop, and women cannot reproduce. Learn more about what causes it, the consequences, and how it is treated.

The Connection Between Eating Disorders and Amenorrhea

An energy deficit occurs when a person eats too little compared with the energy they expend. A chronic energy deficit causes body mechanisms to conserve fuel for critical body processes. Less vital body functions are put on hold. This includes reproduction, which can actually be hazardous to survival when energy is insufficient.

A diagnosis of HA is only made after other causes of amenorrhea are ruled out. However, in the case of an eating disorder, HA is a likely cause, even when weight is not extremely low.

The contributing factors to hypothalamic amenorrhea include energy imbalance, food restriction, weight loss, exercise,stress, and genetics.Each person expresses these factors differently, and each factor contributes in varying degrees to the development of HA.

Energy Balance

Simply put, our bodies need fuel to function optimally. Depriving the body of what it needs contributes to various problems, including loss of menses.

Food Restriction

Restricting the range of food eaten can contribute to the developmentof HA,leading to a deficiency in nutrients and vitamins. Low-fat diets are a common culprit–our bodies need fat to function optimally.

Weight Loss

Low weight and body fat percentage, as well as a history of prior weight loss, can be contributing factors. It is important to point out that some women lose their period at higher weights than others.

Each person’s body appears to have a different weight at which it will function optimally—it is reasonable to believe that as with anything else in the natural world, people’s bodies naturally come in different sizes and shapes.

A common misconception is that one needs to be extremely emaciated to lose one’s period. However, hypothalamic amenorrhea can occur at higher BMIs as well.

BMI Is an Imperfect MeasureBody Mass Index (BMI), which is based on height and weight, is increasingly considered an inaccurate measure of key aspects of nutritional health and body composition including body fat content, muscle mass, bone density as well as other factors such as race, ethnicity, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.

BMI Is an Imperfect Measure

Body Mass Index (BMI), which is based on height and weight, is increasingly considered an inaccurate measure of key aspects of nutritional health and body composition including body fat content, muscle mass, bone density as well as other factors such as race, ethnicity, gender, and age. Despite being a flawed measure, BMI is widely used today in the medical community because it is an inexpensive and quick method for analyzing potential health status and outcomes.

Exercise

Stress

Chronic stresscan lead to increased production ofcortisol.High cortisol levels also appear to inhibit the hypothalamus from releasing reproductive hormones.

Genetics

There is genetic variability in the various factors that determine the sensitivity of our reproductive systems to energy deficits and stress.This explains why some people can continue to menstruate at relatively low weights while others will lose their period at a much higher weight.

The Different Causes of Eating Disorders

Prevalence of Hypothalamic Amenorrhea

It is estimated that HA affects approximately 1.62 million women between the ages of 18 and 44 in the United States and 17.4 million women worldwide.

The presence of secondary amenorrhea (defined as the cessation of regular menses for three months or the cessation of irregular menses for six months) used to be adiagnostic criterion for anorexia nervosabut was removed in the latest update of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5-TR).

While the prevalence of amenorrhea is high among women with anorexia, it has been removed as a criterion because:

Medical Consequences of Hypothalamic Amenorrhea

HA results in estrogen deficiency and the cessation of the menstrual cycle in premenopausal women. This, in turn, has significant effects on the body’s cardiac, skeletal, psychological, and reproductive systems. These effects can mimic menopause and all the physical and psychological changes that it works on the body.

Short-term consequences of the low estrogen that comes with amenorrhea include:Hair thinning or lossBrittle nailsSkin problemsLow libidoVaginal dryness

Short-term consequences of the low estrogen that comes with amenorrhea include:

One difficulty is that many women with HA do not experience their symptoms as bothersome, thus they may be reticent to seek treatment.

Longer-term consequences include:

Treatment for Hypothalamic Amenorrhea

The goal of treatment for HA is to reestablish a regular ovulatory menstrual cycle. Appropriate weight gain appears to be the most important predictor of menstrual resumption.

Typically, all the contributing factors must be addressed: energy imbalance, food variety, excessive exercise, low weight, and stress.

Many women with HA who present to a medical provider are prescribed birth control pills. However, although this may cause a resumption in periods, this does not solve the underlying endocrine problem and its risks, nor help the resumption of normal natural hormone activity.

The underlying HA still needs to be addressed and birth control pills may only mask the problem.

If you are already on birth control pills, be aware that the period you get from birth control pills does not provide an accurate indicator of your health. You won’t be able to tell whether you’d menstruate on your own and whether HA is an issue for you until you go off them.

“If you’re getting your period only because you are on birth control pills, it doesn’t count,” explains Nicola J. Rinaldi, PhD, author of “No Period. Now What?”.

Studies have shown that birth control pills do not help prevent further bone loss. Therefore, birth control pills are not generally considered as a treatment for HA.

It should go without saying that if your HA accompanies aneating disorder, you should be getting help from a professional.Working with a therapist,dietitian, and medical doctor experienced with eating disorders can help you recover from HA. Eating disorder treatment will likely include the goals of eating more, exercising less, and learning to manage stress better.

If you believe you are recovered from your eating disorder but your period has not yet resumed, you are encouraged to follow the recommendations below. Some women may think they are recovered, but still have more work to do in terms of increasing weight or food flexibility.

Eat More

Recovery requires eating enough—not only to adequately fuel current energy needs but to also to make up for the history of under-fueling. For most women with HA, recovery requires eating at least 2500 kcal per day.

Eating a variety of foods from all macronutrient groups, including fats, proteins and carbohydrates seems to be important in the resumption of hormone production. Full-fat dairy may be particularly good for stimulating ovulation.

You may not want to gain weight, thinking that you already feel healthy. However, your body disagrees with you if you are not menstruating due to HA. Try gaining a few pounds and see what happens. You may be pleasantly surprised to see your cycles resume.

Although healthy body weights vary greatly, most women with HA must obtain a BMI of 22 to 23 or higher to resume menses.

Exercise Less

What to Know About Eating Disorders

Stress Management

Research shows that reducing stress can help with recovering from HA. However, you might be managing your emotions in ways that can contribute to HA—strenuous exercise to feel less anxious or restrictive eating to deal with a distorted body image, for example. Learning other coping skills such as relaxation, mindfulness, distress tolerance skills, and sedentary joyful activities can help complete the recovery puzzle.

The length of time it takes to resume regular menses varies based on factors such as rate of weight gain, exercise level, stress level, age, and genetics.

It can generally take women three to six months to regain their cycle after making appropriate lifestyle changes, and it has been found that success rates increase over time.

Keep in Mind

If you’ve lost your period, you may think there’s no reason to be concerned with your health. However, the absence of regular cycles is not normal. You are encouraged to see a medical professional and ask about the possibility of a diagnosis of hypothalamic amenorrhea.

8 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shufelt CL, Torbati T, Dutra E.Hypothalamic amenorrhea and the long-term health consequences.Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581Ryterska K, Kordek A, Załęska P.Has menstruation disappeared? Functional hypothalamic amenorrhea-What is this story about?Nutrients. 2021;13(8):2827. doi:10.3390/nu13082827Rinaldi NJ, Buckler SG, Waddell LS.No Period, Now What?Waltham: Antica Press; 2019.Roberts RE, Farahani L, Webber L, Jayasena C.Current understanding of hypothalamic amenorrhoea.Ther Adv Endocrinol Metab. 2020;11:2042018820945854. doi:10.1177/2042018820945854Fontana L, Garzia E, Marfia G, Galiano V, Miozzo M.Epigenetics of functional hypothalamic amenorrhea.Front Endocrinol. 2022;13:953431. doi:10.3389/fendo.2022.953431Rinaldi NJ, Buckler S, Waddell LS.How long will it take to recover?Altayar O, Al Nofal A, Carranza Leon BG, Prokop LJ, Wang Z, Murad MH.Treatments to prevent bone loss in functional hypothalamic amenorrhea: A systematic review and meta-analysis.J Endocr Soc. 2017;1(5):500-511. doi:10.1210/js.2017-00102Gordon CM, Ackerman KE, Berga SL, et al.Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline.The Journal of Clinical Endocrinology & Metabolism. 2017;102(5):1413-1439. doi:10.1210/jc.2017-00131

8 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Shufelt CL, Torbati T, Dutra E.Hypothalamic amenorrhea and the long-term health consequences.Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581Ryterska K, Kordek A, Załęska P.Has menstruation disappeared? Functional hypothalamic amenorrhea-What is this story about?Nutrients. 2021;13(8):2827. doi:10.3390/nu13082827Rinaldi NJ, Buckler SG, Waddell LS.No Period, Now What?Waltham: Antica Press; 2019.Roberts RE, Farahani L, Webber L, Jayasena C.Current understanding of hypothalamic amenorrhoea.Ther Adv Endocrinol Metab. 2020;11:2042018820945854. doi:10.1177/2042018820945854Fontana L, Garzia E, Marfia G, Galiano V, Miozzo M.Epigenetics of functional hypothalamic amenorrhea.Front Endocrinol. 2022;13:953431. doi:10.3389/fendo.2022.953431Rinaldi NJ, Buckler S, Waddell LS.How long will it take to recover?Altayar O, Al Nofal A, Carranza Leon BG, Prokop LJ, Wang Z, Murad MH.Treatments to prevent bone loss in functional hypothalamic amenorrhea: A systematic review and meta-analysis.J Endocr Soc. 2017;1(5):500-511. doi:10.1210/js.2017-00102Gordon CM, Ackerman KE, Berga SL, et al.Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline.The Journal of Clinical Endocrinology & Metabolism. 2017;102(5):1413-1439. doi:10.1210/jc.2017-00131

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Shufelt CL, Torbati T, Dutra E.Hypothalamic amenorrhea and the long-term health consequences.Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581Ryterska K, Kordek A, Załęska P.Has menstruation disappeared? Functional hypothalamic amenorrhea-What is this story about?Nutrients. 2021;13(8):2827. doi:10.3390/nu13082827Rinaldi NJ, Buckler SG, Waddell LS.No Period, Now What?Waltham: Antica Press; 2019.Roberts RE, Farahani L, Webber L, Jayasena C.Current understanding of hypothalamic amenorrhoea.Ther Adv Endocrinol Metab. 2020;11:2042018820945854. doi:10.1177/2042018820945854Fontana L, Garzia E, Marfia G, Galiano V, Miozzo M.Epigenetics of functional hypothalamic amenorrhea.Front Endocrinol. 2022;13:953431. doi:10.3389/fendo.2022.953431Rinaldi NJ, Buckler S, Waddell LS.How long will it take to recover?Altayar O, Al Nofal A, Carranza Leon BG, Prokop LJ, Wang Z, Murad MH.Treatments to prevent bone loss in functional hypothalamic amenorrhea: A systematic review and meta-analysis.J Endocr Soc. 2017;1(5):500-511. doi:10.1210/js.2017-00102Gordon CM, Ackerman KE, Berga SL, et al.Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline.The Journal of Clinical Endocrinology & Metabolism. 2017;102(5):1413-1439. doi:10.1210/jc.2017-00131

Shufelt CL, Torbati T, Dutra E.Hypothalamic amenorrhea and the long-term health consequences.Semin Reprod Med. 2017;35(3):256-262. doi:10.1055/s-0037-1603581

Ryterska K, Kordek A, Załęska P.Has menstruation disappeared? Functional hypothalamic amenorrhea-What is this story about?Nutrients. 2021;13(8):2827. doi:10.3390/nu13082827

Rinaldi NJ, Buckler SG, Waddell LS.No Period, Now What?Waltham: Antica Press; 2019.

Roberts RE, Farahani L, Webber L, Jayasena C.Current understanding of hypothalamic amenorrhoea.Ther Adv Endocrinol Metab. 2020;11:2042018820945854. doi:10.1177/2042018820945854

Fontana L, Garzia E, Marfia G, Galiano V, Miozzo M.Epigenetics of functional hypothalamic amenorrhea.Front Endocrinol. 2022;13:953431. doi:10.3389/fendo.2022.953431

Rinaldi NJ, Buckler S, Waddell LS.How long will it take to recover?

Altayar O, Al Nofal A, Carranza Leon BG, Prokop LJ, Wang Z, Murad MH.Treatments to prevent bone loss in functional hypothalamic amenorrhea: A systematic review and meta-analysis.J Endocr Soc. 2017;1(5):500-511. doi:10.1210/js.2017-00102

Gordon CM, Ackerman KE, Berga SL, et al.Functional hypothalamic amenorrhea: an endocrine society clinical practice guideline.The Journal of Clinical Endocrinology & Metabolism. 2017;102(5):1413-1439. doi:10.1210/jc.2017-00131

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