Healing Hypothalamic Amenorrhoea (Amenorrhea)

FHA requires us to surrender. A holistic approach to treatment is needed and depending on the person will dictate which areas we need to focus on the most. But all treatment plans will include stress management, adequate calorie intake, appropriate food choices, exercise reduction, sleep hygiene, toxin reduction and the use of nature.



STRESS


With all women experiencing FHA stress reduction and management is priority. It is not realistic to be able to eliminate all stress, however reduction of and managing our response to stress is important. Where possible outsource anything that can be outsourced, especially if work is a driver of stress. Create a to do list and prioritise things that really do actually need to be done. Compartmentalise facets of life, try not to let certain aspects of your life infiltrate other aspects that are currently happy and stress free. Find an activity that is stress relieving for you, (that doesn't include running 10km per day at 90% max effort) – yoga, walking, gardening, meditation, singing, dancing, journaling. Whatever works for you! For me spending time in the backyard playing with my son and dog with bare feet on the grass is my favourite way to decrease stress.


ASSESS YOUR EXERCISE REGIME


Are you exercising too much? Not allowing any rest days. Not recovering appropriately. Pushing yourself when your best option would be to get an extra 30minutes sleep or do some easy more restorative exercise such as yoga. Dial it down.


Exercise is an incredible thing and often in clinic I have trouble getting people to do any form of exercise. However there is a subset of people who do too much, who push beyond what is needed, who don’t listen to the warning signs of when rest is best. They may be on a training program from a coach that is used to old ways of thinking or training men whose hormone’s run on a 24hr cycle and are physiologically different.


Excess exercise is a stress on the body, it causes increased cortisol to be released from the adrenal glands which causes the sympathetic nervous system to dominate, causing you to stay in a fight or flight state; not rest and digest which is needed for recovery. Overexercising reduces the levels of circulating oestrogen and can cause FHA. This will in turn result in lower bone density – even if you are doing weight bearing exercise and potentially puts you at risk of cardiovascular disease.


A sweat spot for the amount of exercise is very unique and individual depending on many factors such as a person’s genetic make-up, other hormone levels, micronutrient levels, gut health, ability to manage stress, recovery, calorie intake and body fat percentage. Also it is important to note that 99% of the population are not elite athletes, exercise and sport are not our livelihood, thus we do not have the luxury of training in the middle of the day with access to state of the art recovery facilities, meal plans, massages and so on. Most are juggling full time work, kids, social lives and the demands of modern day living whilst getting up in the early hours or late at night to fit in exercise. It is all relative and each situation is different.


Look to incorporate more relaxing gentle exercises, it doesn’t matter what it is, as long as you get some enjoyment from it and it is gentle and restorative. Some examples include – yoga, especially yin yoga, tai chi, walking, swimming, gentle cycling (not epic 100km+ up mountains, you know who you are!) and the list goes on. Be creative, make sure its fun and active!


DIET


For too long we have been influenced by the media, our mothers, our grandmothers and basically the world in general that apparently less is more when it comes to food. As a female we have been told we should order a salad, we shouldn’t eat more than males, being smaller is better, that women only need 1200calories per day. Well I’m here to say that’s rubbish. 1200calories per day is basically what a toddler survives on. In order to support our daily functioning, we need to fuel adequately which means we need to eat enough. If you are also exercising this will mean your energy requirements increase so your food intake will naturally need to increase. It’s easy enough to say just eat more to ensure your body is not in a calorie deficit and creating more stress hormones; but the reality is that this is really hard. Whether you are in the thick of disordered eating, have just consumed to little food for your body for too long or genuinely didn’t realise you needed to eat more to sustain your level of activity; eating more and addressing these issues is hard. It carries its own mental, emotional and physical toll.


It requires a lot of positive internal thoughts and changes to ingrained systemic thinking, a lot of negative self-talk often happens in this space. It may be useful to seek out a psychologist or counsellor to help discuss these issues and barriers to recovery. Recognising you have an issue in this space is an excellent first step. Recovery is not linear and there will be big ups and downs.


Often eating more will follow with weight gain, this is also a very hard area for many women. Seeking out support where possible is paramount, deleting any social media accounts that make you feel inadequate or inferior is a good starting place. Learning to love yourself for who you are and accepting your worth is more than the size of your clothes will be liberating. It will free you from many societal pressures or pressures you place on yourself. It’s important to also note that some studies have shown that even just a reduction in intense exercise can see a return in menstrual cycles and for others they may require limiting all exercise, significant weight gain and stress management. We are unique and our physiology and circumstances are unique, we must treat them so.


Stay tuned for part 3 of Healing HA


Image - unsplash, Darius Bashar.

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