The topic of losing the menstrual cycle due to low energy availability is something that affects me very personally and is a struggle I have faced for a long time. Initially, I didn’t want to share my story as part of this educational segment, but I believe that someone might benefit from hearing about my journey to understanding and becoming aware of their own.
First, I would like to explain what the terms in the title of this article actually mean and why addressing them is truly important.
What is hypothalamic amenorrhea and why it should be a topic of interest?
The menstrual cycle is a reflection of a woman's health. If it disappears, the body is often sending an important signal – something is not right. One of the most common causes of menstrual loss (amenorrhea) in young women is functional hypothalamic amenorrhea (FHA), a condition in which the body, due to low energy availability, stops producing enough hormones necessary for ovulation and menstruation.
How Does Hypothalamic Amenorrhea Develop?
The hypothalamus is a part of the brain that controls many bodily functions, including the regulation of hormones essential for the menstrual cycle. If the body detects that it is not receiving enough energy, the hypothalamus may "shut down" the production of gonadotropin-releasing hormone (GnRH), which in turn halts the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH). This leads to a decrease in estrogen and progesterone production, ultimately resulting in the absence of menstruation.
The most common causes of HA include:
- Low energy availability (LEA) – The difference between energy intake and expenditure is too large, often due to excessive exercise and/or a low-calorie diet.
- High stress levels – Psychological stress can negatively affect hormonal balance.
- Extremely low body fat percentage – The body requires a minimum amount of fat for the proper functioning of the hormonal system.
Many studies have confirmed that low energy availability (LEA) is the primary cause of functional hypothalamic amenorrhea (FHA). Research published in The Journal of Clinical Endocrinology & Metabolism (Loucks et al., 1998) showed that reducing energy availability below 30 kcal/kg of lean body mass per day leads to decreased LH production and, ultimately, disruption of ovulation.
Another study in British Journal of Sports Medicine (Mountjoy et al., 2018) warns about Relative energy deficiency in sports (RED-S), a condition that not only disrupts the menstrual cycle but can also lead to decreased bone density, a weakened immune system, and an increased risk of injuries.
How to Treat Hypothalamic Amenorrhea?
- Increase energy intake – The key is to ensure sufficient calorie intake, especially from healthy fats and complex carbohydrates.
- Limit excessive exercise – If a woman exercises too intensively (especially endurance sports), it may be necessary to reduce training volume.
- Manage stress – Practices such as yoga, meditation, and sufficient sleep can help restore hormonal balance.
- Include micronutrients – Vitamin D, calcium, iron, and omega-3 fatty acids can support hormonal health and cycle restoration.
When to seek professional support?
If menstruation has been absent for more than three months and there are suspicions of hypothalamic amenorrhea, it is important to visit a doctor – a gynecologist or endocrinologist. Diagnosis includes hormone testing, an evaluation of nutritional status, and often a bone density measurement.
How to Recognize If Someone Close to You Might Have a Problem?
I would love to give you a clear piece of advice or a tip that would help you notice it immediately and respond in time. However, I myself lived in this state for several years, during which important bodily functions gradually and subtly faded away, and my body lost its vitality.
I don’t want to present my case as a universal example of how it happens or what exactly takes place, as each of us may react differently and experience different changes. I also now understand that the causes of hypothalamic amenorrhea vary, just as the reasons why a woman remains in a state of low energy availability differ. Is it a lack of education? Excessive training volume? The pursuit of athletic or aesthetic goals? It has been proven that in many cases, FHA goes hand in hand with eating disorders or a disrupted relationship with food. That was also my case…
It all started very innocently—from a teenage dissatisfaction with my own body and the ideal I perceived around me, one that I wanted to get closer to. These thoughts were always present in my mind, but as long as I was playing competitive basketball and training 7–9 times a week, my focus remained on performance goals, and aesthetics took a backseat. However, after a serious knee surgery, COVID and lockdowns, a complete change in my daily routine, and later a major life transition, I suddenly needed something to channel all my attention into—a way to feel special.
Like many other young women, I started googling tips and methods on how to lose weight, and the advice was always the same—eat less and exercise more. I was already an active person, and movement was second nature to me. I adopted an extreme routine—I woke up at 4 AM, exercised on an empty stomach for 2.5 hours right after waking up, swam for hours, then went to school (ironically, I was studying sports physiotherapy) and to work (as a waitress working 12-hour shifts). In between, I would go for walks or work out again to burn more calories. I had three basketball training sessions and two games a week. My diet contained no carbohydrates except for fruit, no fats, and I ate only twice a day—at 12:00 PM and 6:00 PM. Looking back, my daily calorie intake couldn’t have been more than 1000–1200 kcal despite my extremely active lifestyle. Over the course of a year, I lost more than 20 kilos, yet I still saw myself as... fat. Within about two months, I lost my period, my hair started falling out excessively, I was constantly cold, I developed insomnia, and my immune system weakened—I got sick very easily. My palms and soles turned yellow, I started growing more body hair, and my athletic performance declined drastically. Mentally, I became extremely irritable, suffered from frequent anxiety and panic attacks. All the joy and energy for life disappeared from me.
What went wrong? I would say it was a combination of multiple factors—my perfectionist nature, the loss of stability and inner direction, societal ideals that subconsciously influence everyone, comments from others, lack of education, and so on. With time and perspective, I understand that some of these factors cannot be removed or controlled. However, there are things that can help as a form of prevention for people around you:
1. Support a balanced diet by encouraging a healthy relationship with food
Make sure your loved ones have a sufficient and balanced calorie intake that matches their energy needs. Help them develop a healthy relationship with food and emphasize that nutrition is not just about calories but also about the quality of food and the intake of essential nutrients.
2. Pay attention to the relationship with exercise
Excessive physical activity, especially when combined with low calorie intake, can significantly contribute to the development of hypothalamic amenorrhea. Encourage your loved ones to allow themselves adequate rest and not to see exercise solely as a way to control weight, but also as a means of maintaining a healthy body and mind.
3. Support them in managing stress
Psychological stress can disrupt hormonal balance and contribute to menstrual issues. Support your loved ones in finding healthy ways to manage stress, such as relaxation techniques, meditation, quality sleep, or activities that bring them joy and relaxation.
4. Pay attention to the body's signals
If you notice that a loved one is experiencing extreme fatigue, a reduced appetite, excessive exercise, or signs of hormonal imbalance (such as hair loss, dry skin, or frequent mood swings), don’t hesitate to gently suggest that it might be necessary to reassess their lifestyle. Approach the conversation with care and support, emphasizing their well-being rather than judgment.
5. Encourage open communication
Many women may see the loss of their menstrual cycle as a personal topic they don’t want to talk about. Create a safe environment where they can openly discuss their health concerns and feelings without fear of judgment. If necessary, encourage them to seek professional help from doctors, nutritionists, or psychologists to support their well-being and recovery.
6. Help them free themselves from societal pressure
Media and societal norms often create pressure to achieve a "perfect body" or extreme performance, which can lead to unhealthy eating and exercise habits. Help your loved one understand that health is more important than any beauty ideal or athletic achievement. Encourage them to prioritize their well-being over unrealistic expectations and to appreciate their body for what it can do rather than how it looks.
Hypothalamic amenorrhea is not just about losing menstruation—it is a warning sign that the body is operating in survival mode. However, by adjusting lifestyle habits, nutrition, and stress management, it is possible to restore the menstrual cycle and prevent long-term health complications.
English 
Slovak