5 Amenorrhea Recovery Signs + Real Case Studies

Today we’re talking about the top 5 signs that indicate you’re making progress in your hypothalamic amenorrhea recovery.

What is Amenorrhea?

Hypothalamic amenorrhea is when your period is completely missing and has been absent for 3+ months and you do have a history of menstruation. This is what I specialize in. Primary amenorrhea is when you’ve never had a cycle but are of menstruating age – often still associated with hypothalamic amenorrhea, just from a young age.

Still, amenorrhea can happen to women at any menstruating age so it’s important to know about it.

There are plenty of reasons why you might have hypothalamic amenorrhea such as over exercising, under eating or chronic stress (learn more about that and how to get started with recovery by listening to The HA Podcast or watching my personal story with hypothalamic amenorrhea here), but this article is dedicated to the signs and symptoms that show your missing period is on the mend!

Top 5 Amenorrhea Recovery Signs

1. Increased Hunger

Many women start their HA recovery journey by increasing their food intake on purpose, even if they don’t really want to eat that much. Amenorrhea is generally caused by an energy and nutrient deficiency which is particularly prominent in today’s society. With so much pressure to be in a smaller body, many women are eating less than their bodies actually require.

Once women start to eat more food than they were previously, they start to notice that their hunger has increased making it easier to eat more food!

Increased hunger once you’ve started to reintroduce food into your system is one sign that your hormones are kicking back into gear, your metabolism is rising and your whole body is experiencing a much-needed refill of energy. This process is crucial for returning your missing menstrual cycle.

Women often worry that they’re “never going to stop eating!” If this is you, don’t worry, it isn’t true! Your body has just been signaled that it’s receiving an abundance of food and now it’s replenishing missing nutrient stores. It’s different from woman to woman, but this stage should only last a few weeks. Once your brain is satiated, it will normalize.

2. Improved Satiation

A nice segway from the increased hunger symptom is improved satiation (I.E feeling full). Being “food focused”, meaning you often think about food, when your next meal is and feel sad when your last meal is over, is a sign that you’re never fully satiated – you’re still hungry! Pair that with having amenorrhea and this is further evidence that you’re in an energy deficit like I mentioned above.

Once women start eating enough to actually stop being so food focused, you can feel confident that your body is getting the energy and nutrients it needs to turn your reproductive systems back online.

Case Study: How This CrossFitter Got Her Missing Period Back

3. Seeing Cervical Mucus

Do you remember, back when you had a regular period, that sometimes you’d get some strange looking mucus land in your underwear? No one ever tells us about this when we’re growing up and many people even associate it with being a problem! Truth is, it’s not just a normal thing...it’s an incredibly healthy thing.

Cervical mucus is produced from the cervix (inside of the vagina) as a result of rising estrogen. Estrogen that is rising higher and higher in an attempt to ovulate. In case you don’t know this already, ovulation is the very important precursor to having an actual period.

This means that when you start to see cervical mucus (creamy white or crystal clear) show up in your underwear or on your toilet paper when you wipe, you can be confident that your brain is signaling to your ovaries to produce estrogen. That means that hormones are getting back on track and so is your period!

Hold up though: cervical mucus doesn’t mean your period is definitely coming, it just means it is TRYING to. It’s one of the strongest signs we have and it will go away if you go backwards and stop eating enough, start over exercising or experience something highly stressful or traumatic. So just be aware.

Want to know more about tracking cervical mucus for HA? Read Fertility Awareness Method for Hypothalamic Amenorrhea.

4. Improved Basal Body Temperature

Did you know that by taking your temperature with a thermometer at the same time every morning before you get out of bed, you can start to gauge your basal body temperature and use it as an indicator of recovery?

Many women with hypothalamic amenorrhea run cold – does that sound familiar? Wearing a jacket in summer? Fighting with your partner about blankets and thermostats? When I work 1:1 with clients I always get them to start taking their basal body temperature and we can usually see that their temperatures are lower than they should be.

A womens preovulatory temperature – I.E the temperature they should be before they ovulate and after their period – should be between 36.4C / 97.5F and 36.8C/98.2 F. Many women with amenorrhea run in the low 36C/96F and high 35C/95F range.

As the client and I are making changes to their lifestyle, nutrition and exercise, we can observe their basal body temperature start to rise up to where it should be.

Then we can see when they ovulated because their temperatures will start to rise even higher, and when their period is coming because it will start to plummet down again. It’s really fascinating actually.

Want to know more about tracking basal body temperature for HA? Read Fertility Awareness Method for Hypothalamic Amenorrhea.

5. Better Mood, Libido, Spontaneity and Outlook

This is one of the best signs of recovery – being in a better headspace!

During HA we’re typically less relaxed, unlikely to be in the mood for sex, completely against all things spontaneous that might take us out of our routine and maybe even have a more glum or less optimistic outlook on life. You might be highly productive, but you’re not highly seductive...

Once you start to replenish your missing nutrient stores and step back from the rigidity of our routine, be it strict dieting or a heavy workout schedule or similar, we start to see our guard come down a little and more fun and relaxation start to enter our lives.

Women and their partners regularly report being happier in their relationship due to an improved sex and social life thanks to the changes that they’ve been making! When we start to make these observations we know that we’re on the right track to period recovery.

One of my favourite examples of amenorrhea recovery being life changing is with The HA Society member Elyse! Read: How Elyse Got Her Period Back from Hypothalamic Amenorrhea.

Fast track your way to getting your period back!

Join The HA Society today and start your journey to hypothalamic amenorrhea recovery along with a bunch of other like-minded, hardworking women!

Research and Studies:

1. Bernstein, Matthew T, et al. Gastrointestinal Symptoms before and during Menses in Healthy Women. 22 Jan. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3901893/.

2. Heitkemper, M M, and M Jarrett. “Pattern of Gastrointestinal and Somatic Symptoms across the Menstrual Cycle.” Gastroenterology, U.S. National Library of Medicine, Feb. 1992, www.ncbi.nlm.nih.gov/pubmed/1732122.

3. Whitehead, W E, et al. “Evidence for Exacerbation of Irritable Bowel Syndrome during Menses.” Gastroenterology, U.S. National Library of Medicine, June 1990, www.ncbi.nlm.nih.gov/pubmed/2338190.

4. Zimmerman, Y et al. “The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis.” Human reproduction update vol. 20,1 (2014): 76-105. doi:10.1093/humupd/dmt038.

5. Battaglia, Cesare et al. “Clitoral vascularization and sexual behavior in young patients treated with drospirenone-ethinyl estradiol or contraceptive vaginal ring: a prospective, randomized, pilot study.” The journal of sexual medicine vol. 11,2 (2014): 471-80. doi:10.1111/jsm.12392.

6. Sirakov, M, and E Tomova. Akusherstvo i ginekologiia vol. 54,5 (2015): 34-40.

7. Mikkelsen, Kathleen et al. “The Effects of Vitamin B in Depression.” Current medicinal chemistry vol. 23,38 (2016): 4317-4337. doi:10.2174/0929867323666160920110810.

8. Baker, James M et al. “Estrogen-gut microbiome axis: Physiological and clinical implications.” Maturitas vol. 103 (2017): 45-53. doi:10.1016/j.maturitas.2017.06.025.

9. Merz, C Noel Bairey, et al. “Hypoestrogenemia of Hypothalamic Origin and Coronary Artery Disease in Premenopausal Women: a Report from the NHLBI-Sponsored WISE Study.” Journal of the American College of Cardiology, Elsevier, 1 Feb. 2003, www.sciencedirect.com/science/article/pii/S0735109702027638.

10. Emma O'Donnell, Jack M. Goodman, Paula J. Harvey, Cardiovascular Consequences of Ovarian Disruption: A Focus on Functional Hypothalamic Amenorrhea in Physically Active Women, The Journal of Clinical Endocrinology & Metabolism, Volume 96, Issue 12, 1 December 2011, Pages 3638–3648, https://doi.org/10.1210/jc.2011-1223.

11. Scott, Erin et al. “Estrogen neuroprotection and the critical period hypothesis.” Frontiers in neuroendocrinology vol. 33,1 (2012): 85-104. doi:10.1016/j.yfrne.2011.10.001.

12. Khosla, Sundeep et al. “The unitary model for estrogen deficiency and the pathogenesis of osteoporosis: is a revision needed?.” Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research vol. 26,3 (2011): 441-51. doi:10.1002/jbmr.262.

13. Clarke, Bart L, and Sundeep Khosla. “Female reproductive system and bone.” Archives of biochemistry and biophysics vol. 503,1 (2010): 118-28. doi:10.1016/j.abb.2010.07.006.

14. Gibson, J H et al. “Determinants of bone density and prevalence of osteopenia among female runners in their second to seventh decades of age.” Bone vol. 26,6 (2000): 591-8. doi:10.1016/s8756-3282(00)00274-x.

15. Karen K. Miller, Ellen E. Lee, Elizabeth A. Lawson, Madhusmita Misra, Jennifer Minihan, Steven K. Grinspoon, Suzanne Gleysteen, Diane Mickley, David Herzog, Anne Klibanski, Determinants of Skeletal Loss and Recovery in Anorexia Nervosa, The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 8, 1 August 2006, Pages 2931–2937, https://doi.org/10.1210/jc.2005-2818.

16. Misra, Madhusmita et al. “Weight gain and restoration of menses as predictors of bone mineral density change in adolescent girls with anorexia nervosa-1.” The Journal of clinical endocrinology and metabolism vol. 93,4 (2008): 1231-7. doi:10.1210/jc.2007-1434.

17. Catherine M. Gordon, Kathryn E. Ackerman, Sarah L. Berga, Jay R. Kaplan, George Mastorakos, Madhusmita Misra, M. Hassan Murad, Nanette F. Santoro, Michelle P. Warren, Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 5, 1 May 2017, Pages 1413–1439, https://doi.org/10.1210/jc.2017-00131.

18. Gordon, Catherine M et al. “Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline.” The Journal of clinical endocrinology and metabolism vol. 102,5 (2017): 1413-1439. doi:10.1210/jc.2017-00131.

19. “Too Much of a Good Thing - Exercise Associated Amenorrhea.” Epigee.org, www.epigee.org/exercise-associated-amenorrhea-late-period.html.

20. Black, Ryan. “Endocrine Society Releases Guidelines for Functional Hypothalamic Amenorrhea.” HCP Live, 23 Mar. 2017, www.mdmag.com/conference-coverage/endo-2017/endocrine-society-releases-guidelines-for-functional-hypothalamic-amenorrhea.

21.  Rinaldi, Nicola, et al. “A Guide to Diagnosing Hypothalamic Amenorrhea vs. PCOS.” By the Authors of No Period. Now What?, edrdpro.com/wp-content/uploads/2018/01/Diagnosing_PCOS_vs_HA.pdf.

22. Gordon, Catherine M et al. “Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline.” The Journal of clinical endocrinology and metabolism vol. 102,5 (2017): 1413-1439. doi:10.1210/jc.2017-00131.

23. Catherine M. Gordon, Kathryn E. Ackerman, Sarah L. Berga, Jay R. Kaplan, George Mastorakos, Madhusmita Misra, M. Hassan Murad, Nanette F. Santoro, Michelle P. Warren, Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 5, 1 May 2017, Pages 1413–1439, https://doi.org/10.1210/jc.2017-00131.

24. Bearden, Caroline Young. “Clinical Nutrition: Functional Hypothalamic Amenorrhea - Today's Dietitian Magazine.” Today's Dietitian, Aug. 2017, www.todaysdietitian.com/newarchives/0817p12.shtml.

25. The Fifth Vital Sign - book

26. Taking Charge of Your Fertility - book