Skipping a workout wasn’t an option. Traveling away from home for just a few days sent me into panic mode. How would I find the right food to eat? Where would I exercise? What if there wasn’t enough time to fit in my run? How would I make my protein shake in a hotel room? Travel was torture.
When I was home I had routine. That routine consisted of three hours of exercise most days. At least two of those hours were teaching fitness classes. A typical day might include an hour of intense, high impact HIIT training in the form of TurboKick and an hour of strength training. I never considered those classes my workout as I was “teaching,” therefore, it didn’t count. So, naturally I would spend another hour or more doing “my workout.” Most days this consisted of a six mile run, an hour or more of body weight training (aka PiYo) or maybe an hour doing HIIT and core training.
This might sound excessive, but frankly what I’ve described is pretty normal for a busy fitness professional. Even more extreme were the hours I spent in my home gym preparing and designing workouts for fitness videos on top of all this. Hours and hours of grueling practice and rehearsal, none of which I considered “exercising” because… well… because I was lost.
I was lost in the diet and fitness culture. And the more I exercised, the more my body adapted. This meant my metabolism began working to conserve energy by slowing the rate at which I burned calories. If I let up just a little on the exercise, I would gain weight almost overnight. To compensate, I cut back on my food intake, eating small fat-free, high-protein meals every two hours.
I was determined to be as fit as possible, but my quest for health and my need to “look the part” crossed over from a healthy pursuit to an unhealthy obsession. And no one thought anything of it because it was all in the name of health.
Little did I know at the time how sick I was. I was depriving myself of the nutrients my body needed to regulate my hormones. I was digging my own hormonal grave!
Have you ever felt like you were in an all out war against your own body? I experienced it first hand and I want to help you if you’re struggling too. Unfortunately, the medical community is not up to speed yet, and hypothalamic amenorrhea is often not diagnosed. Now, looking back, I know that my body was screaming signs at me and I had no idea!
In the peak of my old health habits, I stopped getting my period. Like completely stopped. At first, I thought I was just irregular and I stopped being able to predict when I was going to get it. Ladies, we all know how annoying that is! I dismissed my irregular (or lack of) period as an annoyance and completely ignored the other symptoms that were representing a deeper issue.
Defining Hypothalamic Amenorrhea
Hypothalamic Amenorrhea is a condition where menstruation, your period, stops for several months due to problems involving the hypothalamus. The hypothalamus is a pea-sized part of the brain. It’s located just under the surface of the brain, underneath the thalamus, and above the pituitary gland. I mean if it’s only pea-sized and only takes up less than 1% of the brain, can it really impact us that much? Um, yes. And I learned that one the hard way!
What’s the Hypothalamus got to do with It?
I like to call the hypothalamus the “body balancer.” One of its main functions in the body is to maintain homeostasis. It keeps the body stable. It responds to signals from our internal environment and what’s going on outside of us in our external environment.
The hypothalamus is what helps regulate body temperature (is it warm? Is it cold out?) and hunger levels (are you hungry? Are you feeling full after eating?). It responds to blood pressure, stress, and our circadian rhythms. The hypothalamus also responds to circulating hormones, like how high or low the stress hormone cortisol goes, or how much melatonin you’re getting. For being the size of a pea, it’s certainly got a lot going on.
There are two different types of nerves in the hypothalamus that produce hormones. One set of nerves sends hormones directly to the pituitary gland, which then releases the hormones into your body, specifically, our antidiuretic hormone and oxytocin. If we think about water loss with a diuretic, we want to think about water reabsorption with antidiuretic. The antidiuretic hormone is what causes water to reabsorb at the kidney level. Oxytocin is a happy hormone. It’s also the hormone that stimulates the contraction of the uterus. You might be thinking, now Chalene, why are you talking about these nerves?! Well, because these nerves are also the ones that affect our thyroid glands, the production of human growth hormone, prolactin (responsible for milk production), and all of these other factors that affect our sex hormones (like estrogen, testosterone).
Are you starting to get the idea? If we’re experiencing hypothalamic amenorrhea, it means our hypothalamus has some problems going on. And if the hypothalamus has problems, it affects menstruation.
I had lost my period and began suffering odd bouts of brain fog and hormonal issues in my early 40s. Despite my doctors suggestion, I didn’t suspect menopause, but I didn’t think about what else caused my pesky period to appear and disappear. The term amenorrhea alone means loss of menstrual cycle. To clarify, it’s different than menopause. Onset of menopause is defined as going 12 months or more without a menstrual cycle after reproductive age. So if a woman is in her 40’s and she stopped getting her period, it’s likely amenorrhea. But is it hypothalamic amenorrhea? Let’s learn more…
How Hypothalamic Amenorrhea Develops
Hypothalamic amenorrhea presents itself when the body decides to conserve energy, and therefore, stops menstruating. The hypothalamus says, “something’s off here,” and it tells your body to stop using its energy and resources for menstruation or reproduction.
Hypothalamic amenorrhea can happen naturally, like when a woman is breastfeeding. But the other causes are stress, over-exercising, or weight loss. It can occur due to a combination of all three, or any single factor. Because think about it, if your body has very few calories to work with and it’s trying to keep up with your stress load and excessive exercise, then menstruation and reproduction become last priority.
Aside from low body fat, over-training, under-eating, and heightened amounts of stress, amenorrhea is sometimes due to a genetic abnormality. Specifically, Turner Syndrome. Turner Syndrome is a sex chromosome abnormality in which the majority of these women experience amenorrhea. That’s pretty rare though.
I want to make something clear, there’s a difference between a woman who is genetically predisposed to be very thin, and a woman who is unnaturally thin. “Unnaturally,” meaning they’re intentionally restricting calories, chronically over exercising, and at a body weight that’s lower than what is optimal for them. Their low body fat could be because they’re eating too little fat, not enough calories, heightened stress, over exercising, or have a leptin deficiency. Very little is discussed in the medical community about orthorexia, so it’s rarely identified.
Many “keto for life” people hold onto a high-fat, low-carbohydrate protocol so tightly, for so long, they rarely get hungry anymore. That’s a pretty good indicator of a leptin deficiency! That’s one of the reasons why the 131 Method encourages intuitive eating. So, if you’re not getting your period and you’re like, “I don’t get it, I’m actually eating a ton of food and my exercise isn’t over-the-top, but I’ve stopped having my period”…then yep, you may have a leptin deficiency. Or, it may be the result of a dysregulation of either the pituitary gland or the thyroid.
What to Watch Out For
What I don’t want you doing is thinking that you can just look at someone and go, “Oh they’re super underweight, they must have hypothalamic amenorrhea.” It doesn’t work that way. It’s not something that’s always obvious on the surface, weight is not always the reason. With me it wasn’t! I’m the same weight now that I was when I was experiencing hypothalamic amenorrhea. But my body was showing me other signs.
Are you a walking bundle of emotions? One day you’re good, then the next day you’re on the brink of tears and you’re not sure why. And you’re having difficulty sleeping? Is your hair thinning? Are you always cold? Remember, the hypothalamus responds to the external environment. So if you’re always the one that’s freezing cold and everyone else is like, “nah I’m good,” that’s a sign! This was a big one for me. I was walking around fully dressed in the summer with four portable space heaters, and I was still freezing cold! Not normal.
Like I mentioned before, hypothalamic amenorrhea is often not diagnosed or misdiagnosed. To be clear, I diagnosed myself. When I went to my gynecologist at the time and presented my period problems, I was told to go on continuous birth control. I didn’t even think about how I was living in a state of over exercising. Not only that, but I was leading the charge for so many of my friends and tons of others! This is one of the reasons I wrote the 131 Method book, because I know I have a huge responsibility to help people recognize that the diet/fitness culture is unhealthy and can be taken to the extreme. One of those extremes is undiagnosed cases of hypothalamic amenorrhea.
Gynecologists, like most mainstream medical professionals, typically want to give you a pill, usually the birth control pill to help regulate hormone production. They might even suggest PCOS (Polycystic Ovarian Syndrome). Or, they may simply suggest you “gain weight” or “stop exercising,” which is kinda like telling someone with an eating disorder to “just eat.” It’s not that simple.
Not everyone needs to gain weight or stop exercising completely to break free. It is possible to heal yourself and become free from the grips of orthorexia. It’s not about weight as much as it is about eating the right nutrients, allowing your body to rest, reducing stress and exercising a healthy dose of self-awareness.
My reality of not eating enough calories (or under-consuming the right types of macronutrients for balanced hormones), and overtraining and mistreating my body does not have to be your reality. Each and every woman suffering from hypothalamic amenorrhea needs to approach it from a whole-person perspective. Multiple factors need to be addressed, and underlying root issues should be resolved. In Part Two I’ll share how I healed myself from hypothalamic amenorrhea, orthorexia, and exercise addiction, and how you can heal yourself too.
You don’t need to be a certain size, a particular body weight, or have your body fat at a certain level to be enough. You’re enough, you’re amazing, and people love you. There’s a big difference between an obsession with health and being healthy. I want you to be healthy! I want you to be healthy mentally, emotionally, and physically. But obsessing over health isn’t healthy.
Eager to hear more? Listen to my Podcast episode “Is Your Health Obsession Unhealthy? Warning Signs of Orthorexia and Hypothalamic Amenorrhea.”
Meczekalski, B. “Functional Hypothalamic Amenorrhea and its Influence on Women’s Health”. Journal of Endocrinological Investigation 37:11 (2014) 1049-1056. PubMed. Web. March 26 2019.
Bearden, C. “Functional Hypothalamic Amenorrhea.” Today’s Dietitian Journal 19:8 (2018) 12. Web. March 26 2019.
Shufelt, C. “Hypothalamic Amenorrhea and the Long-Term Health Consequences.” Seminars in Reproductive Medicine 35:3 (2017) 256-262. Pub Med. Web. March 26 2019.
Oktay, K. “Fertility Preservations in Women With Turner’s Syndrome: A Comprehensive Review of Practical Guidelines.” Journal of Pediatric and Adolescent Gynecology 29:5 (2017) 409-416. Pub Med. Web. March 26 2019.