What Is Hypothalamic Amenorrhea?
Hypothalamic Amenorrhea (HA) is more than just a missed period - it’s a signal from your body that something deeper is going on. This page will walk you through what it is, what causes it, how to recognize the signs, and most importantly, how to begin your healing journey.
Hypothalamic amenorrhea happens when your period stops for three months or more, even though you used to have regular cycles. It’s also called secondary amenorrhea or hypogonadotropic hypogonadism.
This happens because a key system in your body called the hypothalamic-pituitary-ovarian (HPO) axis - which controls your menstrual cycle - slows down or stops working properly. Your brain sends signals (hormones) to your ovaries to tell them to release eggs and produce hormones like estrogen and progesterone that cause your period. But when HA occurs, those brain signals slow down or stop. Without these signals, your ovaries pause hormone production, and your menstrual cycle stops.
The main reason this happens is because your body is in a state of chronic energy deficit. That means you are using more energy than you are eating and your body thinks it’s not a safe time to support pregnancy. So it “turns off” your period to conserve energy.
It’s important to know that you don’t have to have an unhealthy relationship with food or exercise to develop HA. Sometimes it’s the combined effect of eating less, exercising more, and dealing with stress over time that causes this energy imbalance.
Your period is a sign of overall health and when it disappears it’s your body’s way of telling you it’s focusing on survival instead of reproduction. And this hormonal change doesn’t just affect fertility. It can impact your bones, heart health, mood, metabolism, and overall wellbeing too.
Signs & Symptoms
Here are some common signs and symptoms of HA beyond missing your period:
Low energy or chronic fatigue
Feeling cold all the time
Trouble sleeping or staying asleep
Low libido
Losing hair, or brittle hair or nails
Digestive issues
Osteopenia or early signs of bone loss
Irregular or missing cervical mucus
Shorter or lighter bleeds, or spotting before your period stopped altogether
Common causes of HA
HA doesn’t happen overnight. It’s usually the result of multiple compounding factors over time, such as:
Under-eating - not getting enough calories to meet your body’s energy needs
Over-exercising - especially high-intensity or long-duration movement without enough recovery
Psychological stress - chronic anxiety, perfectionism, or a Type A mindset
Low body fat or rapid weight loss
Poor sleep or irregular routines
Disordered eating behaviours (even if not a full-blown eating disorder)
The HA Spectrum
There is also something called the spectrum of hypothalamic amenorrhea.
It doesn’t always show up as your period vanishing overnight. It can develop gradually and often gets missed even by healthcare providers. Here’s what that can look like:
Cervical mucus becoming less and less with each cycle
Cycles becoming longer over time (usually due to delayed ovulation)
Shorter luteal phases due to lower progesterone production
Shorter bleeds during your period
Spotting before ovulation or before your period
Cycles occurring every 2-3 months and being misdiagnosed as PCOS when it’s actually HA
So You Have HA… What Next?
The most important thing to know: healing is possible! But recovery requires intention, patience, and a willingness to shift how you relate to food, exercise, and stress.
You Don’t Have to Figure This Out Alone
If you are reading this and thinking “I’ve already tried a lot, and it’s still not working” - you are not alone. Recovery isn’t linear. Sometimes it takes another set of eyes (and someone that gets it) to help guide you through.
If you are ready to feel like yourself again, click the button below to connect and book a free discovery call.