Far back in the very beginning weeks of this blog, I wrote a long series of articles on the sources of infertility.    In terms of the kinds of infertility caused by diet and lifestyle, there are two primary categories: PCOS and Hypothalamic Amenorrhea.  Long time readers of this blog know that I believe the relationship between these two disorders is much more complicated than regular doctors and medicine would have us believe.  Nonetheless, while I was writing about PCOS and HA (read more about HA here and here and here), I promised to write a post on how to overcome HA.

I never did.

The reason I didn’t write it is because the answer is both way too complex and way too simple.  I couldn’t come up with anything coherent to say.

Hypothalamic Amenhorrhea is the fancy way of saying “stress-induced loss of menstruation.”  The hypothalamus is the part of the brain that determines if you are in a safe enough environment to bear children.  If your body receives signals that you are not “safe” enough, then your hormone production will decrease and you will stop menstruating.  You may also suffer symptoms of low libido, depression, anxiety, insomnia, acne, and fatigue.

“Safe” means both physiologically and psychologically.  Mental stress can hurt your fertility just as much as physical stress.  Unfortunately, these two stressors commonly occur in women today, and commonly in paleo dieters.  Mental stress comes from pressure and ambition and work and life as well as body image issues, low-self-esteem, and disordered eating.  Physical stress comes from low body fat levels, rapid fat loss, excessive fat loss, fasting, over-exercising, under-sleeping, and under-eating.   It’s no wonder that so many women struggle with this.



Estrogen, progesterone, LH and FSH — all female hormones — decrease with hypothalamic stress.  LH and FSH come directly from the pituitary and fall off the wagon, and then estrogen and progesterone, which take their cues largely from LH and FSH, fall off of it, too.

Can it be overcome?


Is it easy?

Not always.


The thing about HA is that its severity and “cure” are different for each woman.  The trick is to address all of the kinds of stress that play a role in HA, and to focus on the type of stress that caused your problem in the first place.

For example: say you recently dropped from 130 to 110 pounds.  The primary problem — the thing that if it looks like a duck and quacks like a duck, it’s a duck, so stop fighting the reality of your weight loss — is that you lost too much weight too fast.  Your body couldn’t keep up with your changing leptin levels.  And you likely underate calories and gave your body starvation signals while you were losing.  So that needs to take precedence.  You also, however, exercise a fair bit and have a fairly stressful life.  To that end, you should also reduce your exercise, work on your priorities and your stress level, and be sure to eat as much as you need to.  Address all of the ways in which you can increase your body’s detection of “safety.”  Focus on perhaps gaining a little bit of weight back, however, since that was your primary “problem.”  The faster you can convince your body you are no longer starving, the faster you’ll regain hormone balance and fertility.

Other women, on the other hand, might have to focus on stress, or might have to give up marathoning for a while.

HA is all about convincing your body that it’s no longer in danger.  It doesn’t need to stress.  It doesn’t need to shut down hormone production to prevent a poorly timed pregnancy.  So you have got to nourish it as best you can.  Err on the side of over versus under eating.    Dial down your exercise — particularly the sprint based kind — and do only what feels comfortable.   Stop pushing through being so tired.  Don’t wake up in the morning to an alarm after a short night’s sleep to go for a run.  Be sure to eat plenty of carbohydrates — at very minimum 100 grams of carbohydrate a day — and make sure to eat even more if you are an athlete.   Learn to move more slowly, to eat more gently, to be less hard on yourself.   Relax, eat, relax, eat, relax, eat, repeat.   Don’t eat garbage– no way!  Some women do, and find that their fertility comes back.  But go wild with your diet, and eat as much as you are craving.  Your body has been starved, and it’s important to respond to hunger signals when you have them.  That is, if you want your fertility back.

To that end, there’s a simple answer to HA:

-Eat more.  Relax more.  Repeat.

On top of that, we can get more specific:

-Focus on nutrient-rich foods that support healthy hormone production.  Liver, egg yolks, other organ meats, bone broth, leafy greens, fruits, and vegetables are all great.

-Make sure to eat plenty of fat.   At minimum 40 grams a day.  This amounts to approximately three tablespoons of your favorite paleo oil (such as coconut oil) — one for each meal.   Including saturated fat is particularly helpful since it is the backbone of hormone production.

-Make sure to eat plenty of carbohydrates.  Your body can think it’s starving if it doesn’t get enough for a significant period of time.  Eat at least one piece of fruit or serving of starchy carbs with every meal.  Make sure to do more on active days.

-Eat when you are hungry.  Do not go hungry.  Ever.

-Only exercise when you feel energetic and excited to do so, and refuel appropriately afterward.

-Do not sprint more than a couple of times a week.

-Consider eating a fuck ton of calories.  Many women have spent ages on different forums learning about what works, and debating how many calories should be eaten at any given point in time.    Some argue you need as many as 3000 calories a day to recover.  Others assert 2000.  I wouldn’t go crazy, but consider the fact that there’s a good chance you are undereating relative to your needs.

-Consider weight gain.  Anywhere from 1 pound to 10 might be necessary, or 30, depending on where you are.   How much did you weigh when you stopped menstruating?  Is it much more than where you are now?  How much more?  What else was going on in your life?  You may need to close the gap a bit between where you are now and where you stopped menstruating in order to do so again.  Each woman’s body is different and requires a different level of fat to feel safe and be fertile.

-Sleep as much as possible.  9 hours a night!

-Consider supplementation.  Magnesium supports hormone production.  Calcium is helpful with the magneisum.   Take the magnesium and calcium in a 1:1 or 1:2 (at most) ratio.  Vitamin D can support functions with magnesium and calcium.  Fermented cod liver oil will never hurt.


Which is all that I’ve got.  I know it’s a lot and also a little at the same time.  Hypothalamic amenorrhea is all about you and your body and your own particular needs.  You’ve got to think deeply about the kinds of stress you might be dealing with, and then go ahead and rectify it.

And then give it time.

It takes time to recover from this sort of thing.  Hormones don’t leap ahead of us, they follow behind, peaking around all of the corners, making sure it’s safe before they come out and play.   I can say, however, that your recovery will be faster the more you nourish yourself, the more you eat, and the more you relax.   You can go more slowly if you are fearful of the process.  This is what I did.   And it’s good — the body learns to adjust to new leptin levels over itme.  But know that it takes longer the more slowly and cautiously you move forward with your hypothalamus.

I highly recommend checking out the Fertile Thoughts forum on hypothalamic amenorrhea.   It contains 108,000 posts and counting.  Women all across the world come to this forum to share their experiences with HA and infertility.  Definitely worth the read if you’re interested in HA at all.




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