I don't get my period: Integrative approach to functional hypothalamic amenorrhea

Functional hypothalamic amenorrhea is the lack of menstruation caused by a dysregulation in the hypothalamic -pituitary-ovarian axis. This imbalance is caused by continuous exposure to one or more factors perceived by the body as stressful. That is, your body perceives a constant alert. If we made a comparison with what you think it would be something like "Since I am not going to be able to invest energy in reproduction, it is not the time to menstruate." When the period disappears, you have to stop and reflect on the following:
  • What were your rules like before? When did they withdraw?
  • What is draining your body the most?
  • Is your diet complete and varied? Do you rest adequately? Do you exercise enough but allow yourself to stop when you need to, or do you do strenuous sports or do more than you should for what you are ingesting?
  • Do you have a lot of emotional stress in your day to day?
  • Is your intestine absorbing well what you eat? Are your digestions correct?
  • Have you lost weight very fast?
And here we could continue with a very long etc. In short, the body perceives that there is not enough energy, either because it is not ingested, because it is burned excessively or because rest is conspicuous by its absence (and if it appears… There is more guilt than enjoyment, something that can be equally applied to the possible extras in food). Therefore, the solution is not to eat X calories or weigh X kg, since there may be hypothalamic amenorrhea with widely varying BMIs.

Stress conditions the lack of menstruation

When it comes to acting, the first thing to do is to become aware that stress is causing the lack of menstruation . Hence, the solution involves going to the cause, and the integrative and multidisciplinary approach is key. Therefore, good psychological therapy is important, as well as adequate nutritional rehabilitation , ensuring a complete, varied and sufficient diet. In addition, it can also be positive to work hand in hand with integrative gynecologists . These will be in charge of checking analytical tests, assessing the state of the ovaries and proposing, if necessary, hormone replacement. The latter, of course, will not be in all cases or as the first option. Along the way, it will be necessary to solve all the blocks that may appear , such as phobia of certain foods, rest, weight gain and/or managing stress in more adaptive ways. It will always be essential to understand that the guidelines that are followed are not to seek perfection, since mental flexibility is key to recovery. To do this, look for professionals who make you feel heard and accompanied in the process. And most importantly, never lose sight of the fact that menstruation is a vital sign , a health sign that is related to bone well-being, fertility, performance and concentration, among many other variables.

Food, a key point

From the most absolute flexibility and variety, it is important to regulate caloric intake according to the energy expenditure that we have. On average, accompaniment of 3 to 6 months is usually required in order to achieve a good acquisition of fully adapted eating habits. The diet (and in itself the entire approach to the patient) will depend on the type of stress that caused the condition, although, in clinical practice, functional hypothalamic amenorrhea usually occurs due to a host of stressful factors and a very unhealthy lifestyle. . In addition, it is often related to caloric deficit. The key points to address it will be:
  • caloric adjustment . If there was restriction, sustained caloric increase (about 3 months)
  • Influence the hours of rest and sleep
  • Add strategic carbohydrate refills in the diet, especially on days with more physical or mental demand, until emotional flexibility allows more permissiveness in this regard. The refills can be made with quinoa or sweet potato if other hydrates are not tolerated due to more mental rigidity at the beginning. Be that as it may, adding carbohydrates is essential, since you have to relax the hypothalamus, and the nerve cells respond very quickly to glucose.
  • Ensure that nutritional requirements are covered at all levels and, if not, enrich the diet with minerals (Brazil nuts, molluscs, seeds, etc.), vitamins, proteins of high biological value and anti-inflammatory fats at each meal of the day (extra virgin olive oil, avocados, toasted sesame tahini, eggs, etc.)
  • Make eating behavior more flexible whenever there is high self-demand.

The importance of paying attention to micronutrients

Among the micronutrients, we should not lose sight of calcium , present in cheeses, almonds, chia seeds, enriched vegetable drinks, anchovies, sardines, dried figs, broccoli, etc. In addition, it is advisable to accompany these foods with other foods rich in vitamin D (fatty fish, fatty dairy products, and eggs, among others) and, whenever necessary, vitamin D should be supplemented to have values ​​close to 50. Likewise, we must take into account that diet deficits may have to do with intestinal malabsorption . If so, it will be key to heal the intestine and check the values ​​of vitamin B12, zinc and vitamin D, among other parameters, supplementing whenever necessary. Here, it is important to highlight that, before focusing on amenorrhea, we will have to treat the intestine , ruling out pathogens, taking care of the mucous membranes, supporting digestion with digestive enzymes, etc.) Again, a diet adapted to you will be key, although nutrition is not everything. To reverse amenorrhea, it is important to be very consistent in your habits and regular rest cycles until you achieve at least two consecutive menstruation cycles.

Changing lifestyle habits

Whenever possible, I invite you to spend between 2-7 days of total disconnection before "starting the treatment" , eating what you want, without forcing yourself to do a lot of exercise, it can be just walking, without a mobile phone, etc. Really , if you can afford it, start here. After this time, the complete nutritional approach will begin, which will include the intake of carbohydrates (baked tubers or quinoa, for example) in each main intake, anti-inflammatory fats in each meal and more than 1.2 g of protein for each kilo of weight. This should be explained to you very well in consultation so that you do not weigh or over-calculate the food rations. On a weekly basis, it is positive to propose some "recuperator" higher in hydrates, as well as more flexible and energetic meals according to each case . Any delicious restaurant that you want to try and enjoy focusing on sensations and not on guilt? Go for it. However, do not stop working on guilt management, order your rest rhythms, expose yourself to sunlight every day whenever you can, avoid blue light at night and train more or less intensely depending on your particular case, but never overexerting. Some ideas to do so are:
  • Use blue light blockers on your mobile and start avoiding screens after 9 pm
  • Keep the room cool to sleep
  • Eating dinner relatively early and with easily digestible carbohydrates, such as potatoes
  • Maintaining a social life, reducing self-demand and favoring carefree activities
Finally, in many scenarios, it will be necessary to supplement the diet to promote the recovery of hormonal pulses with vitamin D, carbohydrate and MCT shakes, saffron dry extract, adaptogens such as ashwagandha, GABA, tryptophan, B vitamins, Cimicifuga racemosa, etc.). Whenever they are required, they must be guided by the professionals who handle your case and adapt them to your real needs. There is no rush, little by little. As a team, that's why. Your health will thank you. Listen to yourself, listen to your needs and see allowing yourself to give them to you.
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