Healing Hypothalamic Amenorrhea After Birth Control
Amenorrhea is defined as the absence of a menstrual period in a woman of childbearing age. There are two kinds of amenorrhea: primary and secondary. Primary amenorrhea is when a girl who is 15 years or older has not yet gotten her first period. Secondary amenorrhea is when a woman who has had regular periods in the past stops experiencing them for at least six months or longer.
Secondary amenorrhea can have many causes, including pregnancy, breastfeeding, PCOS, use of the birth control pill, excessive exercise, extreme stress, obesity, a low body fat percentage, calorie restriction, and certain medications.
Birth Control & Amenorrhea
While on the birth control pill, the body does not actually ovulate (this is how there is protection against pregnancy), and menstruation only occurs because of a dip in hormones (the week you do not take the pill every month). Menstruation does not correlate to ovulation, however in order to ovulate and get pregnant, both ovulation and menstruation must occur.
When coming off the pill, women can experience amenorrhea. It can develop at any time while a woman is on the pill, and this typically goes unnoticed while on the pill because the pill creates a menstrual cycle each month, The bleeding you get when you're on the pill is not the same as a menstrual period. When you're taking the pill, your period is technically called withdrawal bleeding, referring to the withdrawal of hormones in your pill. The drop in hormones levels causes the lining of your uterus (the endometrium) to shed. Therefore there is often no way to know that it is a problem until a woman comes off of the pill.
Common Causes of Hypothalamic Amenorrhea
Hypothalamic amenorrhea is due to a combination of five different factors: over-exercising, under-eating, weight loss, stress, and genetics. Any of these factors, or a combination of them, can cause amenorrhea, and until the root cause is fixed, the body will continue to be in this state of not ovulating and/or menstruating.
Looking at the factors individually:
Exercise: Excessive exercise varies from person to person, but when the body feels like the exercise is excessive or like it’s not being properly nourished and replenished after the exercise it’s being put through, this can lead to amenorrhea.
Under-Eating: As with exercise, the level of under-eating or calorie restriction that can cause issues can vary from person to person. Not giving the body enough nourishment and calories can cause it to sense that it does not have enough nutrients and cause it additional stress, leading to amenorrhea.
Weight Loss: Having a lower BMI, typically in the underweight range or on the lower side of “normal,” can cause the body to feel stressed due to a lower body fat percentage, and this as well can lead to amenorrhea. Women who lose a significant amount of weight can also develop it while continuing to have a BMI in the normal or higher ranges.
Stress: Physical or psychological stress that is extreme in the short-term or at a constant level for longer periods of time add to the body’s overall stress load. When the body hits its limits, amenorrhea can occur as it’s more important for the body to manage the stress that is occurring than to allow a woman’s body to be able to reproduce.
How to Reset Your Cycle
Hypothalamic amenorrhea can be reversible, and it is possible to reset your cycle to allow for ovulation, menstruation, and pregnancy. The first step in doing so for hypothalamic amenorrhea is to evaluate which factors you believe are in your life and to correct the ones in imbalance.
Exercise: Take a look at your exercise routine. Are you pushing yourself to your max constantly? Everyone is different and everyone’s body perceives physical stress differently, but if you are finding you are getting more tired after doing a workout (even if it’s yoga!), rather than feeling refreshed, it may be a good time to switch it up.
Try: Something that makes your body feel rejuvenated rather than maxed out. Take breaks as often as you need. Exercise less or integrate more restorative exercise like walking or yin/restorative yoga.
Eating: Listening to your body is important, and playing around with different foods is a good way to find a plan that suits you and your body best.
Try: Eating until you feel satisfied and not hungry. Listening to your body is key. Make sure you have a balance of protein, carbs, and fat at every meal. Women with amenorrhea often need more healthy fats like avocado, olive oil, nuts & seeds + wild caught fish. Eat lots of healthy carbohydrates like gluten-free pancakes, oatmeal, granola, sweet potatoes, parsnips, brown rice, brown rice pasta, gluten-free bread, quinoa, etc. + protein - Lean, pasture/grass-fed meat & wild-caught fish. Probiotic-rich foods like yogurt, coconut yogurt, sauerkraut, kefir.
Foods that help to restore estrogen balance: avocado- eat 1 per day!, + lots of healthy fats, coconut oil, mct oil, eat enough protein at every meal, cruciferous vegetables: broccoli, collards, kale, Brussels sprouts, wild caught salmon, nuts like walnuts & nut butter like almond butter, turmeric, quinoa, eggs, sweet potatoes, parsnips + all root vegetables.
Drink Plenty of Water Daily(1/2 your body weight in oz.) – and never from a plastic bottle – spring water is best or filtered water!
Weight : If you believe weight loss could be a reason why your body has put itself in this state, come up with a healthy plan on how to add some weight to your body comfortably. You want to make sure you feel good about the process and your body.
Try: Putting on weight healthily, slowly and steadily, and feeling comfortable in knowing that adding the extra pounds to your body will help it to decrease stress and reset your cycle.
Stress: Stress can vary widely from person to person. The three other factors above are different stressors your body can perceive as too much and can often be the root cause of the amenorrhea. Other times it’s more complicated, and it could be factors like a stressful work life where you are constantly on the go and work long hours or a strained relationship with a partner or family member that cause you emotional distress.
Try: Finding the root cause of stress in the body, and looking at ways to release it. This could look like changing up your routines, journaling, and seeing a counselor for stresses such as a strained relationship.
With hypothalamic amenorrhea, regardless of the root cause, there are some general lifestyle changes you can make to help show your body you are trying to reduce stress.
Downtime & relaxation: help your body shift out of a state of fight or flight. Say no as often as you need. Get extra sleep. Take more breaks. Schedule less. Do less. Nurture yourself & let yourself just be + doing nothing. Take baths, listen to yoga nidra meditations or other guided meditations, listen to relaxing music, just be + breathe.
Journaling: Taking time daily to breathe or to write down your feelings can really help you to connect more internally. It also allows for the body to reduce stress by getting out of your thoughts and into your body (with meditation) or by releasing thoughts and feelings in a healthy way (with journaling).
Hypothalamic amenorrhea causes stress throughout the body, and stress depletes the body of nutrients faster. When trying to help your body recover, try these supplements:
Full-Spectrum Multivitamin or a Prenatal (if you’re trying to concieve): Look for a good multivitamin with a broad variety of nutrients in their most absorbable forms. This will provide the body with a good base of vitamins and minerals to help replenish the body (take dosage as per bottle instructions).
Magnesium: When the body is stressed it uses up more magnesium than in a non-stressed state. It’s important to replenish the body with magnesium, as it’s responsible for more than 300 functions in the body. Look to supplement orally in the form of bisglycinate or citrate (200-400 mg daily, in the evening), or by taking a 20+ minute bath with 1-2 cups of Magnesium flake salts in the evening.
Omega-3 Fatty Acids: Stress in the body can cause inflammation, which in turn can cause a host of other issues. Omega-3s help the body to fight inflammation, can improve anxiety, and are beneficial for brain health (at least 500 mg daily).
Topical Wild Yam: This contains phytoprogesterones (a natural source of progesterone), which help to regulate the balance of estrogen and progesterone in the body. Using wild yam topically can also be beneficial, as it acts as a natural progesterone cream with great absorption. Follow product label instructions.
Chaste Tree Berry (Vitex): This popular herb supports women’s health by supporting the pituitary gland, which is where progesterone and luteinizing hormones are produced. It helps to balance hormones, help your body ovulate, and ensure regular menstrual cycles. Take 3x per day in capsule or tincture form- for up to 3 months.
Ashwagandha: This is an adaptogenic herb, meaning it helps your body to find balance when stressed, and is considered an overall tonic. Take a tincture 1-3x per day for stress support.
Holy Basil (Tulsi): This is also an adaptogenic herb that helps the body to find balance when stressed. Try as a tea or infusion by taking 1-2 tbsp with 1 cup of hot filtered water daily.
Blue Cohosh: This herb stimulates circulation and helps to encourage menstrual flow. Take in tincture form and follow instructions on label. Do not use if there is a chance that you’re pregnant.
Overall, the body wants to get itself into a state of balance where the menstrual cycle is concerned. Hypothalamic amenorrhea is there as a sign that the body is too stressed, and is trying to protect itself from further harm or stress in the form of a pregnancy that it can’t healthfully support. The body always tackles the biggest threats it perceives first, and leaves secondary problems (like beautiful hair and nails, and a menstrual cycle where you ovulate and can get pregnant) to be fixed once any major threats are out of the way. Remember that your body did not get in this state overnight, and it will take time for it to rebalance. Be patient with your body, and yourself, and use the tools above to help support your body during this transition.