Tips for Pregnancy and Postpartum after Recovering from Hypothalamic Amenorrhea
First, congratulations! I’m so happy for you. Overcoming HA and restoring your period is a huge accomplishment in and of itself! Now, as you embark on this new chapter, it's crucial to approach it with similar care and awareness.
In this blog post, we will provide essential tips to support your pregnancy journey after recovering from HA, ensuring a happy and healthy experience for both you and your baby.
Before we get started, I want to say this:
There is no evidence to suggest that HA affects birth outcomes. Once you're pregnant, you're pregnant. Due to your HA you are going to be in a somewhat nutrient depleted state, it's just how it is. Don't worry, it's more YOU that will bare the grunt of that than the baby. Your body will prioritize the baby in order to make it the healthiest it can be, drawing nutrients from all areas of your body including your bones! This just means that you'll want to take extra good care of yourself and keep that in mind for proper exercise, nutrition and supplementation.
Let’s dive in!
But first, if you’re not pregnant yet and wondering if it’s possible for you to get pregnant if you have or have had HA, check out these two youtube videos I made
Exercise during pregnancy:
If you would rather watch my take on exercise during pregnancy check out this Youtube I created.
In general, take it easy. I know a part of you might feel like you need to push yourself to maintain your current lifestyle AND carry a baby, but that’s the pressures of society. Unfortunately, we live in a society that glorifies burn out, which perpetuates the belief that one must always be working or striving for more to prove themselves. This carries over to pregnancy, pushing women to continue the exact same lifestyle as they did before, disregarding their need to slow down out of fear of feeling inadequate.
That doesn’t need to be your path, if you’ve learned anything from HA recovery, it’s that slowing down is productive. Trust that there is wisdom in the idea of not pushing yourself during pregnancy.
In the first trimester of pregnancy you can mostly do all movements, especially if it’s your first pregnancy (takes longer for your belly to show). Just remember that a LOT is happening inside of your body that you can't see so moving for the sake of blood flow and energy is the key…not to mitigate weight gain. Now is not the time to make performance or composition goals! You're now in pregnancy mode! There are going to be significant physiological and hormonal changes that are happening in order to support the growth and development of a baby.
Hormonal changes: These hormonal changes include Increased production of progesterone, which the research shows can lead to increased joint laxity and flexibility. While this is essential for preparing the body for childbirth, it can also make women more prone to injury during intense exercise or training.
Energy demands: Pregnancy requires a significant amount of energy to support the growing baby and maintain maternal health. Pursuing performance or composition goals may divert energy away from the baby's development and overall well-being.
The research shows us that the benefits of exercise are for increased blood flow to the uterus, decreasing likelihood of gestational diabetes and other health complications. There is NO evidence to show that anything more than chill work out sessions are beneficial at this stage. Your body is so so so busy right now, respect that!
I actually conducted my own research on if exercise is safe during pregnancy or not. Check out this youtube video I created to hear my findings.
Supportive movement during all of pregnancy includes things like walking, light-stretching- nothing too deep that stretches the torso in the second and third trimester.
First trimester, things like pull ups are ok. If you are seasoned, deadlifts and squats that are LIGHT (like, empty barbell, max 35kg only if you're a seasoned lifter) are ok in the second and third trimester. They act more like breathing exercises than strength exercises.
If you see coning in your belly, get looked at for diastasis recti. Your midwife or PT should be able to check you for this.
Exercise after pregnancy:
First, there is a lot of pressure out there to “bounce back” right after having a baby, but again that is the pressure from our twisted society. Returning to exercise or jumping on a diet right away to “lose the baby weight” can not only impact the health of your baby, but also yours.
After having a baby your body needs a lot of nourishment and rest to repair, replenish what was lost and also provide crucial nutrients for your growing and developing baby. This is absolutely not a time to jump on a diet or focus on weight lose. It’s truly a time to rest and restore.
A doctor will usually clear you at 6 weeks but take that with a grain of salt. Know yourself and your mind's tendencies. You have a massive wound healing inside of your body and if you haven't noticed, your vagina has been bleeding non-stop for 3 weeks.
Again, take it easy…seriously! Start with walks, then uphill walks or wooded trails and then bodyweight movements. I personally didn't lift weights until 3 months postpartum.
BirthFIT is a good resource for functional movements through exercise.
Lastly, take all advice with a grain of salt and trust your INTUITION over anything else.
Supplement Ideas:
As holistic fertility coaches, we approach HA and fertility from a whole food-first perspective and there is a very important reason for this…No one understands the delicate balance and needs of our bodies better than mother nature. Whole food from sources like plants, trees, soil, animals and animal products contain all of what we need as long as we eat it in abundance and variety.
However, it's no secret that in our modern world, our soils and animals are becoming more and more depleted. Making it difficult to obtain adequate amounts of the nutrients needed for pregnancy from food alone. We're also coming out of HA. so naturally there is a high likelihood that we are still in a small nutritional deficit. And so, some supplementation might make sense for you. You don’t need to take every single one listed to have a healthy pregnancy, but if you feel called, these are one’s you can’t go wrong with.
Before diving in to these supplement ideas, remember that we are not doctors and to always seek out advice from your doctor.
Prenatal: Recommended prenatal that we are obsessed with- FULLWELL. If you’re not pregnant yet, we do recommend you start taking this in advance. If you’re taking beef liver capsules or eating regular liver, only take a half dose of the prenatal.
With prenatals you have to be really careful, not all are created equal. Most lack adequate amounts of nourishment and or synthetic forms of nutrients that are not well utilized by the body. We’ve researched FULLWELL and it passes our criteria, so you can choose this one with confidence.
Omega-3 DHEA Fatty Acids from fish oil: Omega-3 dietary deficiency is compounded by the fact that pregnant women become depleted in omega-3s because the fetus uses omega-3s for its nervous system development. Omega-3 supports brain and eye development in babies.
Vitamin D: Supports your immune system and the health of your bones, muscles, and teeth. It's also necessary for absorbing calcium and phosphorus. For the developing baby, vitamin D supports healthy bone development.
Lypo-Spheric Vitamin C: Vitamin C is needed to make collagen, one of the fibers that builds your baby's body. So, it's no surprise that your need increases during pregnancy.
Beef liver: Highly, highly love beef liver and I tend to encourage it in all my clients! ESPECIALLY if you are supplementing with vitamin D, because vitamin D depletes vitamin A and beef liver has vitamin A. Beef liver is the holy grail of nutrients and in the fertility space we consider it nature's multivitamin. It's higher in all nutrients than any one food including vitamin A retinol and B12. Another side note, there's a bit of a wives tale out there that vitamin A is bad for pregnancy. The truth behind this is that it's the SYNTHETIC form of vitamin A that is bad and beef liver has natural vitamin A. Also, it's actually reaalllly hard to over consume on vitamin A.
Lilly Nichols has a great article on consumer beef liver/organ meats in pregnancy.
I personally LOVE Grassland Nutrition, so much so that I made them give us a discount code. If you use HASOCIETY at the checkout you'll get 10% off which is fun.
Nutritional tips:
As holistic fertility coaches, we always recommend prioritizing a nutrient-dense diet regardless of pregnancy or not. However, it becomes especially important in pregnancy because you are literally creating LIFE!
Here are some nutrients and foods to prioritize:
Fiber: Eat plenty of foods with fiber. This helps digestion and can help prevent constipation. Consider cooking your veggies i.e. steaming, sauteing - to make them easier on digestion.
Animal protein: Include animal protein sources at every meal. If you're struggling to eat enough meat due to aversions, try cooking rice and pasta in bone broth and cooking recipes with animal protein sources hidden inside. Or try yogurt if you can stomach it.
Below I have broken down some of the most important pregnancy nutrients and they all just happen to be found in ANIMAL PRODUCTS…surprise!
Iron: Iron depletes during pregnancy. You'll find iron in your prenatal and if you take/eat liver. The only extra iron I added in my diet was by cooking with cast iron cookware. You do you.
Choline: Choline is extremely important for placenta development, preventing neural tube defects and supporting proper brain development. The best source will be EGGS! You will also get this from eating liver as well, but one can only consume so much liver…am i right?!
Vitamin A: Vitamin A, aka retinol, from animal sources is essential for proper fetal growth and development of organ systems like the lungs, eyes, thyroid and immune system. Note, beta carotene found in plants like carrots and sweet potatoes- is is NOT vitamin A (retinol) in its bioavailable form. We want the vitmin A from animals products. Great sources include liver, eggs, full fat dairy products and grass fed butter.
B Vitamins (Especially folate): This vitamin is crucial for proper fetal development and preventing birth defects. Best food sources include liver, red meat, well cooked dark leafy greens, eggs and full fat dairy. Note that folic acid is not the same as folate. Folate is the natural form of Vitamin B9, which is preferred over its synthetic friend, folic acid- which is what’s commonly found in prenatals and multivitamins.
Zinc: Zinc deficiency is linked to a variety of pregnancy complications such as miscarriage, preterm delivery, low birthweight, stillbirth, and even neural tube defects. Great sources of zinc include animal products and oysters.
Other uncommon, but important tips:
It's common to wear tight sports bras during pregnancy to help with the tenderness. Wearing tight bras during pregnancy is currently being speculated to potentially cause a lesser milk supply. Just something to consider if you're trying to strap those girls down.
If you're breastfeeding, check your insurance for breast pump coverage and for lactation consultant coverage.
Book in with your postpartum physical therapist in advance because they have 2-3 month waitlists in the US.
Can I have my hair coloured and get my nails done? Answer: YES!
Can I drink zero cal sweeteners? Will cover below.
Resources you might find helpful:
Online know-your-rights and labour courses that are helpful:
Podcasts that are helpful:
Birth Hour - birth stories that you might learn from or be inspired by
I found it good to look into things I may want to start looking at when the baby is older too because once you have the baby you have less time to dive into them. So here are some ideas for podcasts that might be interesting.
GoDiaperFree - all about infant potty training
Babyled Weaning Made Easy - all about babyled weaning
Can I drink/consume artificial sweeteners during pregnancy?
Artificial sweeteners are everywhere thanks to the 90’s diet craze and the demonization of sugar in the 2000’s. There are loads of zero cal drinks and packaged “diet food” on the market. In general it's about weighing out the pros and cons and deciding for yourself if you should include these in your diet or not.
Below is a list of general information about zero-cal sweeteners to help you with your own decision. In my opinion, they are pretty interesting and a good reason to ditch them.
Consumption of sugary beverages is associated with an increased risk for fatty liver disease, which could not be observed in zero calorie beverages. There is conflicting data on short- and long-term consumption of both natural and artificial sweeteners (AS).
The most common synthetic artificial sweeteners used in the food industry are acesulfame K, aspartame, cyclamates, and saccharin, which all have different effects on the body. Some of them are considered to be carcinogenic and interfere with DNA. Regular consumption of AS may lead to obesity, metabolic syndrome, type 2 diabetes and cardiovascular disease. Zero calorie sweeteners have a negative effect on glucose metabolism, gut microbiota, and appetite control.
Consumption leads to weight gain due to increased food consumption and induced hyperinsulinemia compared to the control group who consumed water or caloric drinks. The higher consumption of food is linked to a potential mechanism for diet soda to increase food palatability through activation of the reward system and suppression of inhibitory control.
Taste receptors in the mouth react to AS and modify secretion of molecules (e.g. ghrelin) which can affect blood sugar levels. When consuming foods with zero calorie sugars, the body expects calories coming in, blood sugar reacts accordingly, but then there is no energy intake following.
“Natural” flavors can still contain synthetic chemicals such as propylene glycol, the preservative BHA, and GMO-derived ingredients. They are designed to have addictive ingredients. (lawsuit against Hint flavored water: https://www.foodnavigator-usa.com/Article/2017/01/20/Hint-Water-hit-with-all-natural-lawsuit-over-propylene-glycol)
Some types are carcinogenic, might lead to diabetes, heart disease, metabolic syndrome, preterm delivery, and disturbed gut microbiome over-consumption leads to diarrhea, upset stomach, headache, aspartame may increase hunger, added preservatives can lead to kidney damage
Benefits of Artificial Sweeteners:
Avoiding the potential toxicity of refined sugar, controlling blood sugar for people with diabetes, less harmful for teeth.
Zero calorie drinks, compared to sugary drinks, are gentler on teeth as they do not lead to cavities.
Periods Postpartum:
If you've had a history of a missing period, it's absolutely reasonable that you might be wondering if you'll get your period back postpartum, when you should expect it and what red flags to look out for to tell if it's normal postpartum amenorrhea or hypothalamic amenorrhea.
When you're pregnant you don't get a menstrual cycle because you're pregnant - we know this! But postpartum you generally will not get a menstrual cycle if you're breastfeeding in some way.
Obviously, it's important to know that there are variabilities here. There are women who exclusively breastfeed and do not have a period, this is called lactational amenorrhea. And there are women who half breastfeed, half pump or half breastfeed, half formula. If you only use formula you should expect your period to return sooner than someone breastfeeding.
So, let's say your baby is 6 weeks fully weaned and you're not pumping, you should expect a period. If you're worried, you can go to a doctor and they'll look at your prolactin levels and let you know what's happening. But for the most part, if your period hasn't returned, it's most likely missing due to hypothalamic amenorrhea - meaning your energy intake is not enough and your energy output is too much. So, if you're not eating enough, skipping meals, drinking lots of coffee and exercising a lot to really try and lose the baby weight, these are behaviours that are probably going to put you in that hypothalamic amenorrhea category.
It's important to remember that breastfeeding uses calories. So if you're breastfeeding, but don't replenish the calories or you lost a lot of weight, this is a clue. Look at it this way - 1oz or 30ml of breast milk is about 25 calories so that could end up being 500 calories a day that your body has used to produce breast milk and shows that more food is needed. This can vary. Maybe you're a 'super producer', so that 500 calories a day mark makes sense for you. Maybe you don't produce that much so you, potentially, won't need as many calories. But please note that milk supply is not a good enough indicator of how much food you need to eat. Breast milk quality and calorie intake are more specific to the nutrient composition of the milk, so every women's breast milk is different for their own baby and different to your breast milk so you can't compare. I don't want you to think that just because you're producing less milk, you don't need more calories. And if you're not eating enough or pushing yourself too hard while you're also sleep deprived, because of changes to your sleep or you're just more stressed because you have this other person clinging to you, you also probably need to consume more calories.
In general, if you're now weaning your child onto solid food and they're mostly eating food and only some breast milk, you could probably expect your period to come back at that point.
But if your child is weaned and properly eating solids, replacing meals with real food and it's been over 6 weeks, you probably need to eat more and/or rest more, especially if you have a history of amenorrhea.
Getting the support of other women who have been in your position is really helpful, and is why we have a mums group inside of The HA Society!
Congratulations again and I cannot wait to hear when you get your period back!
You can check out the full video on my postpartum journey here
If you are not pregnant and pregnancy is your main objective or you need help preparing your body for pregnancy post HA, I recommend working with us!
Helping women recover their periods, prepare their bodies and get pregnant naturally is what we do and we will save you significant amounts of money, pain and anguish compared to fertility treatments. Learn more about our coaching here.
