I'm hosting a completely FREE 5-day video course on all things Hypothalamic Amenorrhea recovery, metabolic resetting, overcoming food obsession and exercise addiction and finally arriving at a fit, healthy and athletic physique that you can count on forever. We start on Wednesday, June 3rd. Join here: https://kerstenkimura.lpages.co/burnout-recovery-spectrum/
Resources mentioned in this episode:
Free guide: How to Eat to Get Your Period Back: https://kerstenkimura.lpages.co/how-to-eat-for-ha/
Work with me: https://urbanjane.co/work-with-me/
Program: Get Your Period Back! https://kersten-kimura.teachable.com/p/get-your-period-back
Program: Simple Strength for Women: A Bodyweight Strength Training Program for Women After Hypothalamic Amenorrhea https://kersten-kimura.teachable.com/p/simple-strength-for-women
The Real Reason Your Breasts Are Sore Before Your Period by Nicole Jardim: https://nicolejardim.com/the-real-reason-your-breasts-are-sore-before-your-period/
Video: Overtraining Hormones Recovery https://www.youtube.com/watch?v=JFwMSKHI0WE&t=9s
No Period, Now What book (affiliate link): http://www.noperiodnowwhat.com/book/products?ap_id=kerstenkimura
Do's and Don'ts of Vitex for Period Problems by dr Lara Briden: https://www.larabriden.com/vitex-for-period-problems/
Video: Superfoods for Hypothalamic Amenorrhea Recovery: https://urbanjane.co/blog/superfoods-for-hypothalamic-amenorrhea-recovery/
Video: Periods After Hypothalamic Amenorrhea with Nicole Jardim: https://www.youtube.com/watch?v=y3mwQ64ccsw&list=PL1fM_ku5ax0b_ABMnqEAB4LVKnmSS8XRJ&index=8&t=26s
Program (affiliate): Fix Your Period Track 2 (the one that helped me to get rid of my period pains!): https://nicolejardim.com/fix-your-period-track-2/?oprid=14010&ref=168736
Your Questions About Hypothalamic Amenorrhea Answered!
You probably know by now what Hypothalamic Amenorrhea is. Maybe this is even how you found me, by reading my blog or following me on YouTube?
Hypothalamic Amenorrhea is a condition where you lose your period because you have been under eating, overtraining and stressing your body out in general. I had this condition for 10 years and I recovered from a fully. I actually just celebrated with three years of getting my period back.
Before we get started, I want you to know that I am not a medical doctor. Every decision that you make regarding your health has to be discussed with your doctor before. I'm talking from my experience and what has worked for me and those that I've coached. This information is not intended to substitute professional medical help.
Burnout Recovery Spectrum
If you don't know what the Burnout Recovery Spectrum is, let's first get familiar with that. You can learn everything about it here, but here's the recap.
There are 3 phases in Burnout Recovery Spectrum, and they are
Burnout is the phase where we do excessive workouts, under eat, stress our bodies out so that they stop working properly. This is where we develop Hypothalamic Amenorrhea.
Healing is the phase where we start working on our health, to reverse all the damage we've done. This is where we start healing Hypothalamic Amenorrhea.
Balance is the phase where we are recovered from all our burnout symptoms, including Hypothalamic Amenorrhea.
What I'm describing in today's post, is what mostly happens in the Healing Phase — where we're working on getting our periods back. Now, let's get to it! Here are the questions you asked, and my responses.
How Important is Life Stress In Recovery? I've Gained Weight But No Period Yet.
The first things is this: You probably have not been patient enough. Periods don't come back super fast. For some people, they do — I've seen it happen in as quickly as 4 weeks, but that's an exception and not a rule. For others, it can take 4 months. For me personally took 5 months. So just because it hasn't happened yet, it doesn't mean that it's never going to come back. You have to stay patient!
The second thing to think about is this: Have you done all the things that you have to do, in order to get it back? I'm sure you know already what those things are, but it's worth saying it again: Stop high intensity exercise and long distance cardio (other than walking). I'm talking about long distance running and intense bike riding, intense rowing workouts etc. These are all long distance cardio.
Also, stop HIT training, metcon type of workouts, CrossFit — everything that is too intense. You have to stop that for a while.
You don't have to stop it exercise altogether. Walking is fine. Yoga is fine. Light resistance training might be fine. But if you're still doing intense or long workouts, then this could be the reason why your period has not come back yet.
Now your question, can it be that it's just life stress and I actually don't have to gain more weight? This what almost all my clients have hoped too but I want you to know: 100% of the time the problem has been the weight. Their bodyweight has still not gotten to that point where the period comes back.
Life stress can throw off your hormones and make you skip a couple of periods. But it happens when something acute happens, like death of a loved one, really stressful period in school or at work, traveling overseas can be a stressor… But you don't develop months and years of amenorrhea from that.
Take a look at your history: If you've been overtraining and under eating, lost a lot of weight, then we know the answer and that is not life stress.
Do You Have to Have Breast Soreness?
This was a funny question. I'm assuming that what the person asked was if you have to have breast soreness in order to have a normal period or ovulation.
Breast soreness, if it occurs, occurs usually between your ovulation and your period (luteal phase). But no, you don't have to have breast soreness to to have a normal cycle. This is absolutely not the case. Breast soreness can be caused by estrogen dominance, which means that the balance between estrogen and progesterone is not quite there, and this is not ideal. If you do have breast soreness, it could be caused by estrogen dominance which could be caused by iodine deficiency. Read Nicole Jardim's article on this topic.
But if you if you don't have sore breasts and you ovulate and get your period, that's amazing. You have a good hormonal balance!
Can You Still Do One Hit Workout a Week And Get Your Period Back?
I'd like you to think: Why do I have to keep doing that one HIT workout a week? What does that give me?
I have a feeling that you're still having a hard time of letting go control and you still want to hold on to something…
It's important to understand why it's not a good idea to do high intense to exercise while you're working on getting your period back: It can throw your hormones off even further. Watch this video to learn more.
High intensity exercise elevates our cortisol levels. We don't want to have those cortisol levels chronically elevated. If they are, our sex hormone production will be compromised. So let go that need to do that high intensity exercise and actually get to know your intuition and see what kind of movement you actually need.
This healing phase gives us the opportunity to understand our bodies better. When we ask ourselves what do we actually want to do, then when we're burnt out, our bodies likely tells us that they don'twant to do high intensity exercise. It's actually our ego who thinks that we have to do it.
While I'm not saying that it's impossible to get your period back while you continue to do high intensity exercise, I also want you to ask yourself, why do I want to do that? Why am I willing to put my recovery off so it can still continue to that one workout a week?
Can Recovery Improve Thyroid Levels?
Just like I said earlier, I am not a doctor, and I can't diagnose anyone. Make sure that you always talk to a doctor about your health concerns.
But here's what I have learned: Recovering can improve your thyroid levels too. Very many women with Hypothalamic Amenorrhea, or an eating disorder, have problems with their thyroid. Sometimes these problems actually don't show up in blood tests because only the thyroid stimulating hormone TSH is tested. Oftentimes that comes back normal.
However, there can be a problem on the deeper level and this is the conversion problem. There are two important thyroid hormones: T4 and T3. The body can only use the T3. What happens in many women, although their TSH test comes back “normal”, is that they're not able to convert T4 to T3, the usable form. That's why it's important to get that checked too.
This conversion problem, which I personally have had too, can definitely be caused by too much stress. Under eating, which most of us do in Hypothalamic Amenorrhea, is one common stressor.
This conversion problem can also be caused by poor gut health or problems with your liver. So these are definitely options. But most women who have Hypothalamic Amenorrhea, have been under eating, which has caused their thyroid to slow down. So it's definitely a possibility that your thyroid will come back to normal when you start working towards your Hypothalamic Amenorrhea recovery.
Here's how you know that you may have problems with your thyroid: You are really really fatigued, you are moody, irritable and maybe even depressed. You definitely have body temperature regulation problems, you're often feeling really, really cold, you're losing your hair… When you think about it, these are all really common symptoms in Hypothalamic Amenorrhea, too.
So yes, absolutely, there is a connection between your thyroid and Hypothalamic Amenorrhea.
What Is the Maximum Heart Rate in Hypothalamic Amenorrhea Recovery? When I'm Walking, I Reach 120bpm, Is It Okay?
Like I said earlier, the Healing Phase a really good time to get in touch with yourself and understand what your body needs. That's why I'm recommending everybody to put away those trackers that track your heart rate, steps, miles and calories.
Why are you still tracking your numbers? There's a chance that you still want to stay in control and maybe make sure that you stay in the “fat burning” mode.
If you want to move, go for a walk, walk slowly and enjoy it. We want to reduce your cortisol, this is the goal. The goal isn't to constantly stare at the watch on your wrist and see what it's showing and if we're in the “right zone”.
Later when you get to the Balance phase, then sure, maybe you want to bring some tracking back, maybe look at your daily steps etc. There's nothing wrong with that as long as it doesn't make you obsessed. But while you're healing, I really recommend that you put away your trackers.
There's one more important thing to know. A lot of times we think that having a really low heart rate is a sign of really, really great fitness and conditioning level. However, it's not always the case, especially if you have been severely under eating. Then your heart gets weaker, which is why it's beating slower.
Of course, if you are a really trained athlete who eats properly and has a lot of muscle mass then yes, lowered heart rate means that she has great cardiovascular health. But if you've been starving yourself and doing a lot of exercise and overtrained yourself, then this is not you.
I Am Overtraining And I'm Overweight, Do I Still Have To Eat a Lot To Recover?
First, let's see what overweight means.
If you look at the BMI chart, then overweight starts from BMI 25. However, this is often not overweight for everybody. For example, my BMI is somewhere between 24.5 and 25. With that, I'm really close to the overweight category, however, I finally have my period and I'm feeling much more energized compared to when my BMI was 22. So BMI is not really a good number to look at.
But if you're saying that your problem is overtraining, then the first thing to do is to let go of that overtraining. Otherwise, you're not healing.
In the Healing phase, you're going to do so walking, yoga, stretching and maybe very light resistance training, but you don't push yourself to do a lot of intense exercise or long cardio. Let go of that overtraining and see what happens!
I've noticed that some people are more sensitive to training too much and other people are more sensitive to under eating. For example, I personally know that when I work out too much, my cycle gets a little bit irregular, it comes a little bit later, and my sleep gets worse. I'm definitely more sensitive to exercise. Maybe that's you too.
Is There Anything To Help Reverse Osteoporosis After Getting It From Having Hypothalamic Amenorrhea?
The best thing you can do is to get your cycle back. It's important to also know that your cycle has to be ovulatory because it is possible to just have a period but now ovulate. This is not what we want. We want the full deal!
When we're able to ovulate that indicates that our bodies produce enough estrogen. Estrogen is necessary for us to build bone. So, the first way to reverse osteoporosis is to have an ovulatory cycle every month.
The second recommendation is from the book No Period, Now What. They suggest that high impact training that requires quick change of direction, such as basketball, tennis, soccer etc, are the best activities that aid with bone rebuild.
What Are the Typical Symptoms Of Low Estrogen?
First one is not having your periods or having irregular periods.
Also hot flashes, mood swings, irritability, headaches, painful sex can all be signs of low estrogen. But all these signs can be symptoms of other hormonal imbalances too.
What Do You Think About Using Vitex (Chaste Tree) And Maca Powder To Get Your Period Back?
When it comes to Vitex (also known as Chaste Tree), it's important to work with a professional who can make sure that it works for you. Vitex is a pretty powerful supplement. Here's dr Lara Brighten's article where she explains why it's important to know whether it actually right for you before taking it. There are also a few important things to know (please read the article to learn more): You shouldn't take it too soon after stopping the birth control, or if you're younger than 18 years old, for example.
I personally took it when I was recovering from Hypothalamic Amenorrhea because the naturopathic doctor that I worked with at the time, prescribed it to me.
The second question was about maca. I tried that too when I was ready to do anything to get my period back… But it doesn't work. It's not a magic food. I have a video on superfoods and Hypothermic Amenorrhea recovery which you can check out HERE.
Getting your period back doesn't come down to eating superfoods. It comes down to taking down that workout intensity, eating more, resting more, giving your body the proper nourishment and relaxing.
What Do You Think About Elimination Diets For Recovery?
I don't think that you should do an elimination diet to get your period back. This is again, this is my opinion, but I'm not a doctor. Make sure you check with him or her first.
I personally would not recommend elimination diets for period recovery. What we have to do is to put more foods back into our diets, and not take more out.
Of course, if you have intolerances and allergies, if there's something that doesn't work for your gut, then yes, it's better to leave it out. But don't make that decision just based on the fact that something made your stomach a little bit uncomfortable.
If you've been under eating for a long time, and now you start adding some foods to your diet, your body doesn't have the resources to deal with them. You don't have the gut bacteria because you haven't had these foods in forever, which is the reason why you may get some stomach discomfort. Watch a video HERE. You have to build that bacteria up again and that happens by eating a variety of foods.
In addition, we have to get rid of this mental block that some foods are bad and we shouldn't be having them in Hypothalamic Amenorrhea recovery. Eating a variety of foods is healthy for you, will diversify your gut bacteria, and heal you from Hypothalamic Amenorrhea.
How Come There Are Women Who Eat More, Exercise Intensity, And Get Their Periods Back?
The first thing that's important to understand is that we can't possibly know everything about these women's lives. We don't know how they sleep, what their stress levels are like, how exactly they eat… Maybe they sleep well, have very little stress, they eat a lot, and really don't have any problems with their periods.
Other people exercise a ton, under eat, don't sleep, have really, really stressful work life or home life… Those people are much more likely to have hormonal imbalances such as hypothermic amenorrhea.
Another thing is that we are all different and our stress tolerance is also different. For example, someone can work out intensely 6 days a week and be okay, while for me, that would be too much and I'd lose my sleep and menstrual cycle.
We are all built a little bit differently, we have to honor that and not compare because what works for someone, doesn't work for everyone!
How Did You Get Back to Exercise And Eating More Intuitively After Hypothalamic Amenorrhea? How Long Did It Take You?
I admit that when I started exercising again after a recovery, I did it wrong. I wanted to get back to intense training just like I had done before. But when I tried it, I got really, really exhausted. I burnt out, I had to take two weeks off because my body was really, really tired.
Same thing happened when I tried running for a little bit. Long cardio lengthened my cycle to 47-48 days again.
So I definitely made some mistakes during my post recovery time. This made me realize that this doesn't work for me, I have to do it differently. HIT training was not for me right now. It was too early. Long cardio was not for me right now. It was too early.
I decided to go back to basics. I started doing simple strength training just with bodyweight 2-3 days a week. I remember that at first I was doubting if this is even going to work? Will I be able to get any stronger? But I did. I really got so much stronger because I took appropriate rest days between the workout days, didn't push myself so hard that my body was aching and hurting the day after… I took it really reasonably.
This is how I also created my strength training program which is called Simple Strength for Women. This program is designed for women just like you if you are just recently recovered from Hypothalamic Amenorrhea and want to get back to training but don't want to mess your body up again.
This program really works great. You can watch some reviews HERE and HERE. Honestly, I haven't had anyone who has ever purchased this program tell me that their cycles lengthened or periods went away, or their other burnout symptoms came back. That's why I know that this program really works!
If you're in the situation where you want to start exercising more after recovering from Hypothalamic Amenorrhea, this program is a great resource for you.
My eating was actually quite good already at the end of 2016 when I started my Hypothalamic Amenorrhea recovery. Yes, I had had many problems and even an undiagnosed eating disorder in the past, but by the time I officially started my recovery, I was already eating probably around 2200-2300 calories a day. Of course, I had to up that, but I didn't start my recovery from severe under eating.
Hypothalamic Amenorrhea Is Very Common, Especially In Female Athletes. Why Is There's So Little Science On It?
There's actually not that little science there is science about Hypothalamic Amenorrhea. There are research articles out there.
But for some reason, many doctors don't seem to know about it. And again, if you have an amazing doctor who told you exactly what to do right away, that's great. But I've heard from a lot of people that their doctors didn't know what the case was. Their doctors told them start hormone replacement therapy, or take the birth control pill.
I don't know what happens and why they are misinformed. I don't have an answer to that question.
What To Do If Your BMI Is Close To Being Out Of the “Normal” Range But You Have Hypothalamic Amenorrhea?
Like I said before, BMI is not a good number to look at. While it is true that more women who have Hypothalamic Amenorrhea have very low or medium range BMI, this is not true for everybody.
I wasn't in that range. When I started my recovery, my BMI was 22.1. So I was right in the middle of the middle range, and I still didn't have my period. So BMI is not always a great indicator of your health and what your weight should be.
Of course, you may also have PCOS which is a little bit more common in women who are on the higher side of the BMI. But PCOS has to be checked correctly. Read more about it HERE. Your doctor has to check your hormones and not only look at your ovaries and say that you have polycystic ovaries, therefore you have PCOS. Many women have polycystic ovaries, but they don't have any, any other symptoms or a period or menstrual irregularities! So make sure that when you're diagnosed with PCOS, it's done correctly and that your hormones are tested.
It's important to know what exactly you have because PCOS and HA recovery protocols are completely different.
Lastly, if your BMI is 25 or more, but you know from your past that you have been restricting your food, you've been overtraining and been really stressed out, then there's still a good chance that you have hypothalamic amenorrhea.
Is It Normal to Have Long Cycles After Getting Your Period Back? Do They Get Shorter With Time?
Yes, usually they do get shorter with time. I once did an interview with Nicole Jardim, whose resources I always go to if I have a question about something related to period health.
In this interview, she says that for every year that you missed your period because of Hypothalamic Amenorrhea, give yourself at least one month for your period to become regular. Here's what it means: if you didn't have your period for six years, then you should give yourself at least six months before your period gets regular.
However, there are some women who are naturally are more irregular. I'm actually one of them. My periods are not like clockwork all the time. So it's important that you don't freak out but do your best that you can! Rest enough, sleep enough and keep your workouts moderate. Continue eating plenty and do everything that you can to keep your periods normal.
Most of the times, our cycle lengths get a little bit shorter as we get healthier. At first, right after getting your first period, the periods can be even 50 days apart, then they shorten to 40 and then 30… It's not the same for everybody but usually true that your cycles do get a little bit shorter over time. Give yourself time!
Is Balancing Blood Sugar Important After You Get Your First Period?
I would say that if you don't have any problems, then I don't think that you have to make a special effort to to balance your blood sugar. You know when your blood sugar is not great. You probably feel really hungry is sometimes, maybe even get dizzy… You feel like you're crashing.
I personally had really, really really painful periods which was the reason that I started looking into blood sugar balancing. I learned the tools and what to look for, from Nicole Jardim's program Fix Your Period, track 2. As I was going through the program, I found that some foods, mostly very high carb foods and sugary foods, really shoot my blood sugar up very high. I eliminated them for a a month and when I did, my period pains went away.
But I would say that if you don't have any problems just don't overthink it. You can have your cupcake and your chocolate, don't worry about it too much. If you have some symptoms then then get curious and see what might be going on.
After Recovery, Is It Possible To Exercise More Intensity While Eating Enough?
When you first start your exercise again after Hypothalamic Amenorrhea recovery, please do it really gradually and slowly, just like in my Simple Strength for Women program. Start with 2-3 strength workouts a week and see how your body responds.
Then, if you'd like to, add one more workout and see how your body responds. Do basic strength training that way for a few months before starting to add in more intense stuff.
If your body responds well, your periods are good, you don't have any symptoms coming back then sure, you can try adding more intense exercise and see how your body responds. But always keep an eye on your symptoms!
All this advice is for you only if you are fully recovered, once you are in this Balance phase that I'v been talking about, not when you're still in the Healing phase and working on your Hypothalamic Amenorrhea.
Is It Possible To Recover From Hypothalamic Amenorrhea Without Having To Stuff Yourself All The Time?
This is a tricky question!
We want the recovery to feel normal. But at the same time, there's going to be a little bit of pushing which is going to be a bit uncomfortable. That's because a lot of times there will be moments when you're already full when you realize that you still haven't eaten as much as you should. You wonder: How the heck am I going to put even more food into my body??
But we have to realize that as a result of under eating for years, we are now in a situation where we get really really full even after eating 1200-1400 calories, which is very low.
Here's how we can eat without feeling stuffed but still get the calories in: Eating more calorie dense foods that are low in volume. Think nuts, seeds, chips, nut butters, chocolate, cheese… This is how you get to your calorie target (if you are counting — you don't have to) which for most women is around 2500, according to No Period, Now What. Remember that this is the minimum, not the maximum.
Of course if we eat a huge huge salads that are very filling because of their fibee and water content, we feel overly full. That's why I don't recommend eating large salads. You can eat salads, but they shouldn't be the main meal, they should be the side.
Eating should be fun and enjoyable, but there will be times where you may have to push a little bit to get some extra calories in. Remember that you're eating to heal, and calories are your medicine.
Any Supplements You Recommend For Hypothalamic Amenorrhea?
Note — these recommendations are based on my personal experience or resources that I trust. Check with your doctor!
Magnesium is a great supplement for everybody who has any period issues, including missing periods. Magnesium is one of the minerals that gets depleted when we have a lot of stress in our lives — and most people do.
The other thing you may want to try if you have hard time just calming down, is an adaptogen called ashwagandha.
Also vitamin D is going to be also really, really helpful.
There's another supplement that's called a ALC. I never tried it personally but Dr. Nicola Rinaldi has recommended it in this article. She says:
“Acetyl-l-carnitine appears to lead to increases and decreases in hormones as are expected and necessary for recovery of periods missing due to hypothalamic amenorrhea. (e.g. GnRH, LH, estradiol, cortisol…) I think that this is a very reasonable supplement to take as you work toward recovery, assuming you are not taking any medications that interact (please check with your doctor and pharmacist).”
However, none of these supplements or adaptogens will bring your period back if you don't eat more and exercise less, if you don't recover and rest enough!
What Do You Do If You Got Your Period Back And Then Lost It Again? Do You Have To Go All In Again, Not Exercise, Eat 2500+ Calories?
It's really important that you monitor your symptoms all the time when you start exercising, to avoid any symptoms from coming back.
You have to know your symptoms! Maybe your sleep gets worse, maybe your cycles are getting super long, maybe you're skipping ovulation, your period went away… These are all the signs that yes, something's happening in the body.
Don't let that go too bad and go back to that burnout phase, because you were already balanced, right?
Don't let things go on for months and months, before you start doing anything about it.
As soon as you get that first sign, you're going to go back and see: What did I do differently last month? What may have caused it? How can I fix it?
Let's say that you started doing fine five intense workouts a week and your period went away. What do you do? It doesn't mean that you are back in your Burnout phase. It just means that you're going to cut back from five to two workouts per week and see what that does.
This is how you find your true balance: You adjust.
Besides, you don't have to push yourself all the time and mess with that delicate balance all the time. Because remember, if you have already been really burnt out once, there's a higher chance that your burnout symptoms will come back if you don't keep your symptoms in check. So please take care of yourself!
Is Recovery With Low Carb Possible If They Are Irritating, As Long As I Eat Enough Calories And Rest Enough?
I don't know why the carbs are irritating for you, but one reason might be that you have been on a very low carb diet for a long time and your body's just not used to it.
Overall, carbohydrates are really incredibly important for women to ovulate and to have our periods.
Low carb diets can increase your cortisol, slow down your thyroid, cause insomnia, hypothermic amenorrhea and constipation.
So, carbs are really important because they give your body the energy that he needs to keep all these functions working properly.
If you've been on a very low carb diet, you want to actually start gradually bringing them back gradually because they are really necessary for us.
It's also worth mentioning that low carb diets work for some women, but we're not all the same — if your periods went away on low carb, that's not for you.
And what's even more important to note: A lot of times those who do promote these really low carb diets are men… Men and women's bodies work really differently.
In general, it is really important that you get adequate amount of carbohydrates to get your periods back. It's not even a bad idea to eat those quick carbs that are often labelled as bad carbs. If you're being really under eating, these types of carbs are really fast to digest. So go ahead and have some of those and see what happens!
This is it for today's post! I hope you found this post helpful! If you have any other questions, please reach out to me.