One of the most common questions I get in emails, on social media and here on the blog is how to overcome hypothalamic amenorrhea.
Most specifically, women want to know: how do you eat for hypothalamic amenorrhea? how much do you eat for hypothalamic amenorrhea? When do you eat for hypothalamic amenorrhea?
Hypothalamic amenorrhea, given that it’s the condition of having starved (intentionally or not) your body into a state of infertility with low calorie diets, fasting, or excessive exercise, requires a lot of nourishment and care.
I personally have done it. (And overcome PCOS at the same time, too.) I have coached countless women through it.
And you can do it, too.
Eat for Hypothalamic Amenorrhea: The General Principle
First and foremost, you need to eat.
Normally, our culture tells people to “eat less, exercise more.”
For hypothalamic amenorrhea, usually the problem however is that you have followed this advice. So now you have to reverse it.
You have to eat more, and exercise less. You have to relax. You have to give your body the nourishment (in the form of calories) it needs in order to consider itself well-fed. You have to reverse the damage done to your hormone signalling mechanisms from months, years, or even decades of under-feeding yourself.
You have to focus on your health, wellness, fertility, happiness, and activities rather than on the specific size of your body.
You have to learn to accept your body as a soft animal, and let it be the size that it wants to be.
Then nourish yourself to high heaven, focusing on eating more, eating plenty, eating bountifully.
Here are the primary pieces of advice I give to all women I encounter with HA:
Eat for Hypothalamic Amenorrhea: Specifics
1. Eat more
You are probably used to eating at least half of what you should be. So eat more. A lot more.
Shoot for at minimum 2000 calories a day. If you are active, make it 2500. Julia Ross says that she believes all women should eat 2300 calories a day.
I don’t recommend counting calories precisely – but it can be important for a lot of people starting out with eating more to keep at least ballpark figures in mind in order to make sure you eat enough.
2. Eat when you’re hungry
Do not go hungry. Whenever your body detects hunger signalling hormones, it decreases thyroid and sex hormone production. In order to properly produce these hormones and get your fertility, sex drive, clear skin, and strong bones back, eat whenever you feel hungry.
3. Don’t stop eating until you’re reasonably full
Many people who suffer from hypothalamic amenorrhea eat regularly but always try to stop themselves from reaching a state of fullness. This ridiculously just deprives your body of good satiation hormones it needs to get “fed” signals. It also sets you up for more hunger faster.
4. When in doubt, eat more rather than less
If you don’t know if you’ve eaten enough, go ahead and eat more. There is nothing to fear – in terms of your health – from eating more food, especially if it’s nice, healthy whole foods. There is a chance you might gain a few pounds, especially if you are under your body’s currently desired set point due to your previous behaviors. But this will not be a bad thing. This will be a good thing because it means reassuring your body it is being fed.
5. Eat when you wake up
While you are sleeping, technically you are fasting.
After dinner and a full night’s rest, you have probably gone 8-14 hours without food.
You might wake up and not be hungry, but that is probably because you have conditioned yourself out of it. So eat when you wake up. Even if it’s just one or two hundred calories, that’ll be enough to break your fast and let your body know that today you are going to eat.
(Also: feel free to eat right before bed!)
6. Forget “3 square meals”
In paleo and other health spheres online, you will often hear people say that you should only eat in 3 square – or even 2 square – meals a day.
They say – don’t graze.
But here’s the thing:
Everybody has a different cure.
For someone dealing with diabetes, eating in meals could help them manage their blood sugar and insulin levels.
But you do not have diabetes.
You have hypothalamic amenorrhea. What works for someone else is not necessarily what works for you. What cures someone else is not necessarily what cures you.
The answer for them is to eat in meals. Your answer is to eat when you are hungry. And if you want to – you can eat all day long. Eat in six small-moderate sized meals if you like. Or eat in 5. Or just simply snack all day, if that’s what you feel like.
The point of eating to overcome hypothalamic amenorrhea is to eat, and to eat bountifully, and to assure your body that you are fed. Restricting yourself to three square meals a day is not the right course of action for you.
Of course, if you still want to eat in three square meals a day, you are more than welcome to. Just make sure that you still hit your 2000 or 2500 calorie minimum, and that you never force yourself to feel hunger between the meals.
7. Get all the macronutrients
Don’t be low carb.
Don’t be low fat.
Eat plenty of both. Your body needs fat to manufacture hormones; it needs carbohydrates to feel good and fed, as well as to produce thyroid hormone.
I recommend starting with 150 grams of carbohydrate a day for overcoming hypothalamic amenorrhea.
Start also with 50 grams of fat.
Get at least 50 grams of protein.
Now of course you’ll notice that adding up 50 grams of protein, 150 grams of carbohydrate, and 50 grams of fat is still much less than 2000 or 2500 calories. This is true. I am not saying that you should eat these amounts, but that they should be your absolute minimum for that particular macronutrient. If you don’t like fat all that much, just make sure you eat at least 50 grams, then fill up the rest of your diet with carbs. If you are the opposite and don’t like carbs all that much, make sure you still get at least 150 grams and fill up the rest of your diet with fat.
Set macronutrient minimums, not maximums.
8. Focus on quantity, not quality
Now, this is the exact opposite of advice I normally give people when they are trying to be healthy.
One of my favorite things to say is that people need to focus on the quality of their food, and care less about the quantity.
In general, this is great advice. High quality food is super important for being healthy in the long run.
But for overcoming hypothalamic amenorrhea, what you actually need more than anything is calories.
So, yes, if you decide to eat all 2500 calories a day in the form of vegetables and fruits and other paleo delights, you are more than welcome to.
I personally got my period back when I added chocolate and oat cereal to my diet. A good friend of mine got hers back when she was going through a period of anxiety and ate a lot of candy. No joke. What your body needs is energy. Quality is important, but you have got to make sure you get the quantity you need. Do what you need to to make that happen.
Beyond food: Overcoming hypothalamic amenorrhea
Bonus point 9. Exercise less
Exercise less. A lot less. If you have cut back on exercise and still haven’t seen results, keep cutting back. Just a couple work outs a week (and not 90 minutes in a spin class) and some gentle walking or yoga is a great way to go. Don’t make yourself work out if you don’t have the energy, and don’t stress your already tired body.
What your body needs now is gentleness. Let it be gentle.
Here is a list of indicators you may be over-exercising.
10. Don’t nitpick your weight
When women are overcoming hypothalamic amenorrhea, they almost inevitably express concern to me about their weight.
They say – “I know I might have to gain weight, but how much?” “Will I have to go back to how heavy I was before?” “Will I become heavier than I was before?”
The thing is – the relationship between weight and hypothalamic amenorrhea is different for everybody. Some gradually gain a little bit of weight until they start to menstruate. Some don’t gain weight but simply benefit from eating more calories. Some people swing up high in weight and then come back down. Others swing up higher in weight then don’t come back down.
So the only advice I can give you, if you really care about your period, your fertility, your sex drive, your strong bones, your clear skin, your good sleep, and your improved calm and mental health, is to learn to be okay with a bigger, squishier body.
I did. You can read a bit about my journey in this post here on being sexy while gaining weight, this one here on our lack of objectivity about our size, this one here on the health benefits of gaining weight for me, or in this book – in which I also give my best advice for body acceptance – here.
So that’s my advice on how to eat for hypothalamic amenorrhea.
Soon I will release a meal plan for those of you who would like more guidance. In the meantime, simply follow these ten guidelines. More food, at more of the time, with more relaxing. It’s simple – but it truly is the trick to eating to overcome hypothalamic amenorrhea.
Also, if you happen to be one of the 15% of American women who has PCOS – or maybe you have hypothalamic amenorrhea but also don’t quite fit the bill – check out this post on how you can have PCOS and hypothalamic amenorrhea at the same time.