You can lose your period and still have hypothalamic amenorrhea, even if you are at “normal” weight.
If you have lost your period, be sure to download this guide that tells you exactly how to change your diet to get your period back.
When I first started doing my research and trying to figure out why I had lost my period, I came across some blogs that talked about it. But most of them were written by women whose bodyweight was relatively low. By low, I mean at the lower end of what is considered “normal” range on the BMI scale (normal is 18.5–24.9). There were also many women whose BMIs were below that, less than 18.5.
There were women who had done figure or fitness competitions and gotten their body fat percentages extremely low, even 14 or under. Together with that, also their bodyweight dropped quite a bit, so their BMIs were somewhere around 15-17.
There were runners whose BMIs were equally low, because they either thought lighter weight helps them to run faster (not necessarily true, because extremely low weight also takes away your strength and overall energy), or they just got so obsessed with being thin that they just ran a lot and ate minimally too maintain that skinny body.
There were girls who had gone through anorexia or other eating disorders or were struggling with disordered eating habits. Also their BMIs were anywhere between 15 to 19… all at “underweight” or low end of the “normal” bodyweight range.
That's what I found from blogs. All the more “formal” information, for what you may, for example, hear from your doctor, only confirms it: If you aren't underweight but have no period, you can't have hypothalamic amenorrhea. Worst case scenario, your doctor tells you not to worry and wants to put you on the birth control pill.
But DON'T do that.
Instead, start eating right… Read this guide to see exactly how.
Why I Thought I Can't Have Hypothalamic Amenorrhea
Of course I was confused – why did I lose my period?
I was not underweight. Even at my lowest point about 10 years ago, my BMI was still around 19, so technically I wasn't underweight even then. (However, I now realize that I was very, very thin at BMI 19!)
When I searched online, I was able to find only a handful of stories from women who weren't that thin but had hypothalamic amenorrhea. There were a few examples of girls whose BMIs were around 22 or even more, but really just a few.
On one hand, I started to realize: It is possible to lose period even if you aren't underweight. It happens to girls whose BMI is “normal“!
[tweet_box design=”default”]It is possible to lose period even if you aren't underweight. [/tweet_box]
On the other hand, I still wanted to fight and deny it. I thought: These few girls must have been just exceptions… I'm different!
I thought I was different, because
- I had gotten rid of binge eating a few years ago and ate normally now, didn't restrict calories or even count them
- I had broken up with the scale years ago and totally embraced the idea that how much I weigh doesn't matter
- I was only working out about 30 minutes a day (although I didn't realize that I was actually moving much more than that)
- I thought I looked totally healthy and definitely not underweight.
So why did I lose my period then?
My acupuncturist wanted me to weigh myself, and I did it, after not having touched the scale for years. It showed 152 lbs, meaning that my BMI was 22.1.
Could I still have hypothalamic amenorrhea????
It Really Was Hypothalamic Amenorrhea
You don't have to be underweight or wear a size 0, to lose your period. As it comes out, it happens also to those whose BMI is 18.5-24.9, or is, in one word, “normal”.
It seems to be true that majority of girls who lose their periods have a BMI that puts them to “Underweight” category, or at least to the lower end of the “Normal” category. But it's not always the case.
This book proved it perfectly. The authors conducted a survey, and the results showed that
- 16% of the respondents had their BMI at least 21 (considered normal) when they realized their period was gone
- 3% had their BMI 23 (also normal) when they realized their period is missing.
- These women were still having hypothalamic amenorrhea.
After reading this study, the picture cleared up for me a bit. I also started thinking back to my exercise, weight loss and dieting history, and found many things that pointed to hypothalamic amenorrhea.
Why You May Lose Your Period, Even If You Are at a Normal Weight
There are a few things I learned (from the book and from my own experience) that showed me that low BMI isn't a good criteria for “diagnosing” hypothalamic amenorrhea.
- Body fat matters a lot. BMI doesn’t say anything about body composition. A person with normal or even high BMI may have significant amount of muscle, but female hormone production requires enough body fat. If there isn't enough fat, you can't have your period. And what's enough for each unique body, is very individual.
- You may lose your period only because of overtraining, even if you eat sufficiently. Read Christina's story to learn more about it. Constant training means constant stress on the body. Some of us handle it better, others worse. Even though exercise may alleviate our mental stress, it is physical stress for the body.
- If you ever lost some weight, even if it was just 10 pounds and even if it happened years ago, that may have been enough to stop normal hormonal production. For example, ten years ago, I lost 30 pounds. Over time, I gained about 20 back, but I still didn't get my period. Part of it was because as I switched from running to strength training, I put on a lot of muscle but not so much fat (see point 1 above). But the damage I did 10 years ago, was still affecting me. My period came back when I gained back all 30 lbs, and no, it wasn't just muscle — I needed more body fat too.
- If you limit your calories or try different diets over and over again, you may lose your period, even if you aren't underweight. Our bodies don't like this type of yo-yoing. Say that you're limiting your calories a lot and your body is starving. At one point, you can't handle it anymore and you binge, eating all you can. Your body doesn't feel safe and your hormone production may be disturbed if you keep going from one extreme to another.
- You may lose your period because of stress. It's super rare, but it's possible. Most women have the combination of over exercising, under eating, and mental stress, which, by the way, is largely caused by the first two! Please don't make the mistake of saying, oh, it's just my mental stress, I can still keep working out as long as I reduce some mental stress. You likely need to deal with the whole package. I actually thought at first that in order to get my period back, all I have to do is to get rid of my mental stress, but I didn't want to admit that I was still working out too much and didn't have enough body fat.
- We’re all different! Let me say it one more time: We're all different! There are women who can do figure competitions, drop their body fat percentages to 15 and still have a period and even get pregnant fairly easily. And then there's you, with BMI 22, 23 or 24 and NOT getting a period. It doesn't sound fun but that's just how we are – different. Our eyes, skin color and hair are different, and so is our natural body weight, as well as our ability to handle stress, physical, mental and emotional.
If you’re someone who doesn’t have a period but isn’t underweight, know that you may still have hypothalamic amenorrhea. I was like that and despite of not wanting to admit it, that was exactly the case.
The cure? Commit to recovery fully, reduce physical, physiological and mental stress and your period will return. You don't only restore your cycle, you also take your health back.
Severe overtraining can cause loss of period, and you don't have to be underweight for that to happen.
If you need support on your journey to recover from overtraining or hypothalamic amenorrhea, you can apply to work with me.
Thank you for taking the time to share your knowledge and experience with hypothalamic amenorrhea. I am so confused on what steps to take and your blog above does push me in the goin’ all in direction.
I have been off the pill for two years now and only had one (halfass) period half a year ago with Christmas (obviously I was elated!). My gynaecologist diagnosed me with PCOS but I never got a withdrawal bleed from the progestin challenge and all my hormones are on the low to very low side (including testosterone). I think it might me HA, but my dr. has never really heard of that and tells me my weight is great and my exercise normal. My bmi is about 20.5 and I never lost a lot of weight. I do not restrict eating although I do eat very healthy (and I have been a vegetarian since childhood). I exercise 3 times a week, heavy weights only, for about an hour.
I tried everything from vitex to dong quai to no coffee (hard!) to 3 months of acupuncture every week to daily meditation. I read the ‘period repair manual’ and many blogs and forums. I learned a lot but still have not regained a cycle. I am on the verge of going to the hospital to maybe start hormonal treatment and then found your blog. I would love to know if you think going all in might be the answer for me. I also just ordered the ‘No period now what’ book.
Thank you for writing all these very helpfull blog posts!
Kersten Kimura says
Thank you for reading 🙂
I’m sorry to hear that your doctor hasn’t heard about HA. But quite honestly it’s not very surprising, many doctors haven’t… PCOS comes with very specific characteristics, like high androgen levels, excess hair in places that are unusual for women, etc. Do you have any of these symptoms?
Your BMI is on the lower side; eating “very healthy” as you say, is another red flag in my mind. It might be that you aren’t getting enough calories.
I would start by simply starting to eat more, and taking off labels “healthy” and “unhealthy” from foods. I’m assuming that there are probably a lot of foods that you consider “unhealthy” and you may end up avoiding things that would actually be helpful.
It’s true that 1 hour weights 3x/ week doesn’t seem like a lot for most women with HA, but it might be a little too much at this point of your life. I would take a break from that too.
Let me know how it goes for you and you can also contact me via email if you have more questions!
Thank you for your answer! I have none of the PCOS characteristics. So after reading this blog I have been ‘all in’ for two weeks now. No exercise and no food restrictions while eating a lot. After two weeks this is already getting easier! Thank you so much for this blog post. I guess I knew, but always reasoned that I was not extreme enough to be HA. I will let you know if in a few weeks or months my cycle has returned. I think it will!
Thanks again, Best, Maria
Kersten Kimura says
Oh, I’m SO glad to hear you started! Yes, let me know how it goes. It many take 3 weeks or 6 months, but it will happen! 🙂
Samantha Fairley says
Hi there, thanks for sharing your stories and information. I wanted to express my interest in the raw food women who have reported that they are simply able to conceive and ovulate without periods, because they say if you eat absolutely zero toxic substances like meat and dairy products and have zero intake of air pollution(almost impossible in major cities) it’s believed that the intelligence of the womb will recognize that it does not require rebuilding the placenta, because it remains in optimal health!
Kersten Kimura says
Hi Samantha, thanks for your input. I personally don’t think raw food diet is the answer. Eating only raw food will mean for most people that they will miss out on important nutrients that simply aren’t present in raw foods. There are many excellent and very clean sources of meat and diary. Eating only raw food also means that it’s extremely hard to eat 2500 calories a day that is needed to restore menstrual cycle, and if one tries to get this amount from raw foods only it means they will likely end up with digestive issues (like bloating).
Wow, thank you so much for this article. I lost my period when I was 16 and was put on birth control to regulate it. I was on birth control for 9 years and decided to get off to try and get pregnant. It’s been a month and my period is MIA. I’m extremely actively but no longer underweight (i’m a good weight for my height). I’ve been convinced that my period is missing (and was missing at 16) because I have serious issues. This article has helped me relax a little bit about my situation. So far being off the pill hasn’t caused any major concerns minus my period being gone. Thanks again for the great article.
Kersten Kimura says
Katie, you’re welcome. I’m just curious to know what those serious issues are that are not letting you get your period… If can and want to talk, let me know! Also, the weight and height ratio isn’t necessarily the whole truth… My weight was seemed to be totally normal too yet I had to gain a bunch to get my period.
I’m a bit of hypochondriac so i’m worried I have PCOS, ovary failure or something of the sort. I’ve been researching ovaries issues like crazy and convincing myself something is wrong. Coming across your article give me a bit of comfort because when I was younger the doctor believed hypothalamic amenorrhea was the issue. The reason why I had a hard time accepting that is because they never ran any blood tests so no one knows for sure. For me stress + exercising a lot is something I need to work on because I believe this will affect my period negatively. I’m worrying about not getting my period and i’m not going to get my period because i’m worrying and it’s a vicious circle. Thanks for listening!
Kersten Kimura says
Katie, I totally get you. It can be a vicious cycle for sure. Some women say that they can’t stop exercising when they have HA because that would cause them too much stress. However, the stress response we get from exercise is often more impactful than the mental stress when we can’t work out. Instead, we can find ways to reduce our stress in different ways that don’t require physical activity (or at least not working out).
If you’d like to chat and help you figure out if it can be HA, let me know 🙂 It’s better to deal with it as soon as possible!
Hi how many calories should I aim for to get it back?
Hi, I’ve never commented on something like this before, but I’m genuinely curious on what others in similar situations may think.
I’m an early 20s female. I DO have stress issues, depression, anxiety, etc. I DO have eating issues, not like the average restrictive disorder, but more like really picky eating. I am not underweight though, I believe my BMI ranged from 21-22, average body fat percentage too. I have bloodwork done regularly since I take daily medication for depression and anxiety, and my doctor likes to stay on top of any damage to my organs that could cause in the long term. My iron, thyroid hormones, blood sugar, and other commonly checked levels are all perfect.
I started taking Yaz birth control when I was a preteen, so I was approaching 10 years of usage when I stopped around a month ago. For the last at least 3 years (max of 5 years) I have had absolutely no period, but my doctor didn’t seem worried when I told her a while ago during a routine pap smear. I stopped the birth control partially because I plan on starting a family in the next couple of years and I heard of people taking a little while after birth control to get their hormones back to normal. However, the major reason was I just feel a little uncomfortable with the idea of not having a period for so long even though my doctor wasn’t worried, and thought maybe it was the birth control that eventually made it disappear.
Mostly just looking for opinions from others if they think this could be a hormone issue or if they are in a similar situation. I know its only been a month after stopping, so it’s completely possible I will start my period again soon. I don’t have any excess hair growth that might be associated with PCOS. Additionally, even before I started birth control, my period wasn’t particularly heavy, I would call it a regular to light flow. Lasting maybe 5 days, in 27-28 day intervals.
Kersten Kimura says
I recommend around 2500. Here’s a good video about this topic where I talk about counting calories and other important things about nutrition and hypothalamic amenorrhea! https://www.youtube.com/watch?v=iT3V2M2ZKuI
Let me know if you have questions! 🙂
Kersten Kimura says
Yes, sometimes it may take time for the body to start menstruating after stopping the Pill. However, if you didn’t get your monthly bleed even on the Pill, then I do think something is hormonally wrong. As I mentioned in this article, you don’t need to be underweight to lose your period due to hypothalamic amenorrhea, this weight that is normal on the BMI scale may simply not be right for YOU.
If your plan is to start a family in the next few years, I would really start figuring out NOW why you aren’t getting your period, as getting a solid ovulation and menstruation and getting pregnant can take time! If you have any questions, please feel free to contact me! 🙂
Hi! I also haven’t had a proper menstrual cycle (although the majority of my life) since this time last year. I’ve been to the doctors but they say it’s not a concern unless I am trying to get pregnant and have dismissed it as PCOS. This isn’t reassuring as I would like to have a normal cycle as it seems natural and healthy.
I am a normal weight at present (114lbs at 5’7) but similarly slightly on the lower side of normal. I am also really active but this is so beneficial to my mental wellbeing as also physical as I am type 1 diabetic. It’s also means I eat very clean with limited sugar and carb intake and have recently gone veggie. In the past I have suffered from ED and have therefore been at a low weight for a lengthened period of time which my body may be sensitive to.
I don’t appear to have the PCOS symptoms ie. excessive hair not the classic symptoms of endometriosis. Your blog and the responses have therefore come as a massive reassurance and has encouraged me to take w few of your suggested steps to restore a cycle.
Any other recommendations based on anything of the above would be much appreciated as it is a massive anxiety for me which consequently probably doesn’t help the issue itself! Thanks you ☺️☺️
Kersten Kimura says
Did your doctor run tests to confirm your PCOS? Common signs of PCOS are usually, as you mentioned, facial hair, but also severe acne, elevated androgens and of course polycystic ovaries. Without these, and especially knowing your ED and exercise past, it’s more likely HA.
I’m quite sure your ED past is contributing to your amenorrhea. I understand that because you’re diabetic, you can’t eat as many carbs, but try to really get your calories up with the foods you can eat. I respect your choice to be vegetarian, but I’m also concerned that cutting out another major food group is not making things any better!
Yes, exercise is beneficial for your mental wellbeing, but it can cause more harm than good. In other words, when done in excess (for YOUR body and in YOUR current situation), negative effects on the physical health outweigh the positive effects on your mental health. I hope this helps!
If you need more help, be sure to check out my program as well – it has all you need to know to recover. https://kersten-kimura.teachable.com/p/get-your-period-back
My daughter is 22 and weighs 57 kilos .. her BMI is 20 .She has just recently lost her periods ( 2 months ago ).
3 months ago she noticed that her weight had increased a bit so she decided to go on a 1200 calorie diet and upped her exercise intensity in the Gym . She lost around 2 kilos and her periods stopped .
3 years ago she was diagnosed as having anorexia and her weight was much less than it is now but she still got her period then ..
So I am confused how come her weight was very low few years back and still had her period while now she is 14 kilos heavier but lost her period
It’s very difficult to convince her to eat 2500 calories a day .. I only managed to convince her to eat 1800 calories a day and to replace her gym with walking and yoga
Do you think this could be enough ..I really don’t know what to do
Kersten Kimura says
I think the reason is this: She’s a grown up woman now, but three years ago, she was still a girl. Her caloric needs have changed. Her body needs more resources (aka, fat percentage, little more weight) than she did when she was still a teenager.
It can also be that her anorexia and long time starvation have caused her body to become more sensitive so now she needs a higher fat percentage for her body to function properly. 1200 calories a day is incredibly low.
Sure, you can start out by 1800 calories, but if this is not enough, you need to have her eat more. Food is really the main thing! You can also check out my program that has all the other steps that she should take every day, to get her period back. You can find it here: https://kersten-kimura.teachable.com/p/get-your-period-back
I hope this helps! Good luck!
Hello! I find this article pretty interesting as I myself haven’t got my period for around three months now and I really need help.
A little back-story first, I was 16 when I started dieting to lose weight, which I did. However, it was pretty fast (around 20 in two months or so). I am not underweight nor I have too low body fat percentage, but I am at the low end of the healthy weight range. Right now I am on a second type of hormonal pills to help trigger it as the first ones did’t work.
I cut back exercise and eat more, but still nothing. It honestly scares me as I don’t want to put on weight and want to maintain my current physique. Do you have any advice? What can I do?
Kersten Kimura says
Unfortunately, our BMI may not be a very good indicator of our health at all. You say that you aren’t underweight or have too low bf %, but they may be too low for YOUR body. I too had a BMI of 22.1 an never had flat abs, yet I still had HA and had to put on weight to recover.
I understand that you don’t want to lose your physique – no one does but sometimes we have to do what’s better for our health.
I’m not sure what pills you are taking. Is it Provera? Birth control? If BC then they do not trigger natural menstruation, ever. You need to get your period back naturally, BC doesn’t hep you with that.
I’m working with women with HA. Please fill out this form if you’re interested in learning more!
Do i have to gain back all the lost kgs that i have lost by dieting to get my period back?
I am a 15-year-old girl and I haven’t had my period in 7 months. I am a normal weight for 15 (5’6 and 120 pounds), my BMI is 20 and I am eating 2000-2100 calories per day. I started getting periods at age 12. I have struggled with anorexia in the past, but I have not been underweight since december 2017.
I had a bit of a rought patch from september 2019-april 2020 where i ate 1700 calories a day, but at the end of april I increased this to around 2050.
I just want to know what I need to do to get my period back as my mum is worrying and is keeping a close eye on what i eat, making sure I am eating enough. I was eating the same amount when I was getting a regular period from january 2018-october 2019.
Kersten Kimura says
You have to likely eat much more than that. You can read No Period, Now What which tells you exactly what to do to get your period back.
Kersten Kimura says
Very likely, yes.
What about for older women? I am trying to figure out if I’m dealing with amenorrhea from overtraining / underfueling or premature menopause (only 44 with no family hx of early menopause). I can’t seem to find any information and naturally my doctor doesn’t know. I tried upping the calories via intuitive eating and greatly diminished my training, but the only thing that happened was weight gain (which was unwanted and unnecessary) and some spotting after about 2 months of less than 40 miles a month (which is normally what I do in a week!). My BMI is at the upper end of normal – I do a ton of strength training as well as run many miles and surf as much as I can. Getting older has meant quite a reduction in calories to keep my body composition where I like it to be to start with. I feel best when my weight is crazy high (like 24.9 BMI) and I run WAY FASTER. Any insights would be so appreciated.
Kersten Kimura says
The best way to know if it’s HA, is to look at your exercise and eating history. Was there a period of weight loss? Have you been dieting and under eating a lot? Do you get enough rest, or are you hardy ever taking days off? Are you constantly cutting your calories?
BMI is not the best indicator of our health.. Some women need to get to a higher end of the “normal” BMI, even if they feel like it’s unnecessary – but that’s what the body needs. I personally had to get my BMI to close to 25 for my period to return.
You can also get your FSH and LH levels checked, those are usually on the lower end when a woman has HA.
So glad I found this post, it proves the suspicions I’ve had for a while that periods really are linked to how much I’m eating. I had really irregular periods for the last 3 years which I was putting down to stress and anxiety. I lost a couple of kilos over that time from stress but as I’m already on the smaller side it was just too much for my body to handle especially combined with a lot of exercise. Since getting a new job and eating normally again (actually more than normally as I’ve taken up weekend cycling which requires a lot of fuel and also lockdown = more snacking) my periods have suddenly gone back to a normal 4 week cycle. Im heavier than ive been in a while but I feel much the better for it.
Kersten Kimura says
That’s great! Sounds like your body really needed some extra fuel. So glad you’re doing better!
Ashley Cox says
Thank you so much for your article. I have always had irregular periods. About 8 years ago I was diagnosed with Grave’s disease (hyperthyroidism). I am now in remission with normal thyroid levels (woot woot!) but unfortunately have not regained my cycle. The last time I was regular was about 4 years ago. I was dealing with Grave’s and on medication, AND about 10 pounds heavier. I have been going through several diagnostic blood panels with my gynecologist and she is at a loss as to why I am not getting my cycles. She has put me on progesterone for 10 days to cause a withdrawal bleed which happened successfully twice in the last year but those have been the only 2 times I’ve bled since December of 2020. I am at my wits end and then I found your blog. I’m going to try to gain those 10 pounds back and see what happens. Wish me luck!
Kersten Kimura says
I’m glad your thyroid looks better! If the only thing that was different before now (now period) and 4 years ago (no period) was your weight, then there’s a good chance that your body wants some of the weight back. Periods can go away with weight loss, especially if the weight loss is sudden. I recommend to start eating more, but you don’t have to increase your intake massively and overnight. Stay patient! Good luck and keep me updated!
I have been trying to find information excluding being underweight and counting calories. Thankfully I have never suffered from wanting diet or lose weight- I’m at the heavier end of ‘normal’ at 10 stone and 5,5. I have no issue with my weight. I had been completely regular before I started taking the pill, then 5 years of pill use (withdrawal bleeds like clockwork in the breaks) I lost my period. I got this checked out at the doctors and they seem to think it is PCOS (though I have zero other symptoms of this and cysts on the ovaries can be caused by long term pill use). I do however, exercise. I don’t know what is classed as excessive but I run around 35 miles a week. Other than that I am pretty much desk bound. Over the last 6 months I have had two very random and severe fractures in the sacrum which apparently is a rare bone to crack. I’ve never broken a bone or had so much as a filling but there are now investigations under way to see if my oestrogen levels are affecting my bone health. I have not upped my physical intensity at all and in fact I would say it’s decreased from last year when I was training for marathons. That being said, I had an induced period to start fertility treatment (the induced period was more like spotting) and after that I actually came on a natural period on my own, followed by a second natural period bang on time 4 weeks later. I’m now hoping and waiting on a third and wondered if the inducement has kickstarted something in me to start my periods again. It has been almost 2 years since I stopped the pill. I am having to rest for another 3 months due to my sacrum fracture too. I’m so confused as to what to do, it seems like a catch 22 situation to me. Could it really be the running that caused it to stop or a combination of the pill and that? I was running during the time the two periods happened so it wasn’t like I was resting then. Thoughts?