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Updated: Dec 17, 2020

END OF STORY. Period (see what I did there).

Fellow runners, did you know endurance athletes are at an increased risk for menstrual irregularity than most other sports? The drive for leanness, high personal standards and perfectionism have been established as key risk factors. Sound familiar? Yeah. Same here.

Hypothalamic Amenorrhea (HA) is one, among many reasons that you may not be having your cycle. It is important to see a doctor or specialist to exclude all other diagnoses, even if you suspect that you may have HA.

Defined, HA is “the absence of menses (your period), caused by a suppression of the hypothalamic-pituitary-ovarian (HPO) axis, in which no anatomic or organic cause is found”.

Essentially, a diagnosis of HA means you are no longer getting your monthly cycle due to lifestyle factors and not because something within your body stopped functioning properly on its own.

To complicate things a bit further, there are actually two different types of HA; primary and secondary. Primary amenorrhea is when you have never had a first period, while secondary is when you have had your first period, but you are no longer menstruating now.

Let’s talk about how HA comes about. Remember that HPO axis I mentioned in HA’s definition? This means that the hypothalamus, pituitary and ovaries work together to help you to cycle properly. The hypothalamus is very sensitive to external signals, and when these signals are stressful they can suppress the hypothalamus - throwing the entire axis out-of-whack. When the HPO axis is functioning normally, it releases hormones to stimulate your menstrual cycle; gonadotropin-releasing hormone (GnRH), which stimulates the creation and release of luteinizing hormone (LH) and follicle stimulating hormone (FSH) from the pituitary. These hormones are released in a cascade-like effect, relying on each other for the cycle to continue. When the axis is out-of-whack, GnRH is suppressed - subsequently suppressing LH and FSH, reducing the level of these hormones in your body. These levels get low enough to make your period go MIA.

That was a lot. Basically, your reproductive system is complex and relies on many moving parts to function optimally. When external lifestyle factors get in the way, your reproductive system is suppressed and shuts down - and why your body is no longer allowing you to have a period.

Lifestyle factors known to trigger the suppression of your reproductive system include one, or a combination of;

  • Excessive exercise

  • Inadequate energy intake

  • Psychological stress

  • Weight loss

HA is not exclusive to eating disorders, low BMI’s (<18.5kg/m2), or elite athletes. Amenorrheic athletes (or your everyday recreational athlete) can be seen with or without intentional energy restriction and across the spectrum of BMI.

So, you may be thinking, “will not having my period really impact my health and running all that much? I mean, not having to deal with a monthly cycle is kind of nice - right?” No! And here’s why.

The hypothalamus (one of the essential parts of the reproductive system) not only controls the reproductive system, it also plays a role in things like:

  • Metabolic health (impacts your hormones that regulate appetite)

  • Bone health

  • Regulation of body temperature

  • Sleep pattern

Along with the reproductive hormones discussed in how HA comes about, another important hormone is suppressed. Estrogen (a sex hormone), is also decreased. Estrogen is important in the building of your bones and your heart health. Low levels of estrogen are also linked to low libido (sex drive), vaginal dryness, and moodiness (yikes!).

Low estrogen = low bone density/formation. Low bone density/formation = increased risk of stress fractures or broken bones. This means you will spend more time injured, and less time running.

Long-term consequences of HA include; increased risk of infertility, Osteoporosis or Osteopenia, and it may even negatively impact your cardiovascular system.

Now for some good news! You’re not broken beyond repair. In fact, there are nutritional and lifestyle interventions to help regain your MIA period. As an RDN, I can help guide you to start the journey of resuming your period. This may include; increasing energy intake, altering food choices and the spread of your energy throughout the day, inclusion of supplements, decreasing/temporary elimination of exercise, and working on your relationship with food, exercise and your body.

Thanks for being here,

Maddi Osburn RDN LD


Interested in working with me? Click here to learn more and schedule your free 15-minute consultation today!


No Period Now What? By Nicola J. Rinaldini.

Where Have the Periods Gone? THe Evaluation and Management of Functional Hypothalamic Amenorrhea. DOI: 10.4274/jcrpe.galenos.2019.2019.S0178

Functional Hypothalamic Amenorrhea: case presentations and overview of literature.

IOC Consensus Statement on Relative Energy Deficiency in Sport. 2018 Update.

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