The Hormone and Anxiety Connection
October 3, 2024
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Clients ask me all the time, “Is it normal to miss a period?” Many women have experienced missing a month of their period and wondering why, and also wondering if they should be concerned.
It’s a common misconception that the only reason you need to balance your hormones or address issues with your menstrual cycle is because you want to get pregnant.
And yes, it’s important to get your body in optimal shape—nutritionally, physically and emotionally—prior to getting pregnant …
BUT
Balanced hormones and a healthy menstrual cycle are crucial for your overall health and wellness—both mentally and physically!
Your hormones play a huge role in:
If it’s a bodily function, your hormones play a role.
So, what happens when your hormones are out of balance and you lose your period?
Let’s dive into the research and find out.
It’s completely normal to miss a period here and there at different times in your life.
Amenorrhea is an often overlooked condition, especially if someone is not particularly bothered by the absence of their menstrual cycle, as it only seems to be a necessity when they’re ready to get pregnant.
What many women don’t recognize is that future hormonal health and fertility can suffer lasting consequences from this severe lack of hormone production—not to mention the nutritional deficiencies.
Amenorrhea is a good example of why we should think of our menstrual cycle as a vital sign of overall health and wellness.
It’s completely normal to miss a period here and there at different times in your life.
For example:
Amenorrhea (uh-men-o-REE-uh) is when you don’t get your period at all for several months at a time (aside from being pregnant and while breastfeeding), and it’s not normal.
No period = estrogen deficiency.
The loss of estrogen has profound effects on many systems throughout the body including cardiac, skeletal, psychological, and reproductive.
Primary amenorrhea is when menstrual periods haven’t started by the age of 16 years. This is more of a rare occurrence and not the norm.
Causes of primary amenorrhea include:
Secondary amenorrhea is when periods stop for 3 months or more in a row by someone who has had periods in the past. This is normal in pregnancy, while breastfeeding, and in the lead-up to menopause; beyond that though, secondary amenorrhea is not normal.
Some causes of secondary amenorrhea include:
Hypothalamic amenorrhea is a type of secondary amenorrhea, and it’s the most common type of amenorrhea that I help clients treat.
Hypothalamic amenorrhea (functional hypothalamic amenorrhea or FHA) is a condition where you don’t get your period (menstruate) because of a problem involving your hypothalamus.
Your hypothalamus is the control center of your brain—it regulates many bodily responses such as your temperature, hunger and certain aspects of reproduction. Specifically, it releases gonadotropin-releasing hormone (GnRH), a hormone that works with follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estrogen to regulate menstruation.
When it comes to your menstrual cycle, GnRH is responsible for triggering your pituitary gland to produce FSH and LH. These two hormones tell your ovary to release a mature egg (known as ovulation) during each menstrual cycle. Without sufficient levels of FSH and LH, ovulation and menstruation stop.
The three most common causes of hypothalamic amenorrhea (FHA) are:
Excessively low body weight — about 10% under normal weight — interrupts many hormonal functions in the body, potentially halting ovulation, and menstruation. Women who have an eating disorder, such as anorexia or bulimia, often stop having periods because of these abnormal hormonal changes.
When we are in a stressful situation, cortisol is released by the adrenal glands. This adrenal response prepares the body for a “fight-or-flight” response. Cortisol shifts our bodies into survival mode in a number of different ways—primarily by impacting your hypothalamus (the area of your brain that controls the hormones that regulate your menstrual cycle), and tells it to stop producing the hormones that initiate the menstrual cycle. When you are chronically stressed, the hypothalamus disruption can cause a temporary, or permanent, pause to your menstrual cycle.
Women who participate in activities that require rigorous training may find their menstrual cycles interrupted. Several factors combine to contribute to the loss of periods in athletes, including low body fat, stress, and high energy expenditure.
Often, it’s a combination of all of these factors that lead to FHA (like exercising too much + not eating enough calories). This puts your hypothalamus in survival mode, and therefore certain bodily processes and functions—such as your menstrual cycle—are put on hold so the body can focus on the most important tasks to staying alive (like breathing).
We often think of athletes or Olympians as having hypothalamic amenorrhea due to their activity levels, but it’s also common in teenagers and anyone experiencing stress from work or home.
The female athlete triad is a medical condition with three parts. Women with the triad may:
Some athletes, especially those in sports that emphasize leanness, may believe that getting to a state at which they’re not having periods (amenorrhea) will help them go from normalcy to excellence.
In fact, amenorrhea can be a sign of relative energy deficiency in sport (RED-S), a syndrome of poor health and declining athletic performance that happens when athletes do not get enough fuel through food to support the energy demands of their daily lives and training.
Amenorrhea will result in low estrogen levels in the body. Estrogen is an important hormone for many functions of the body and low levels of estrogen can cause a multitude of concerns:
Estrogen is responsible for maturing your eggs in preparation for ovulation, in addition to building a thick uterine lining to support successful implantation of an embryo. If you don’t ovulate or build a healthy uterine lining, and therefore don’t have menstrual periods, it’s difficult to become pregnant. When hormone imbalance is the cause of amenorrhea, this can also cause an increased chance of miscarriage and other problems with pregnancy.
A long-term disease, osteoporosis makes your bones less dense and more fragile. Early onset osteoporosis can cause premature menopause and aging. And get this—women with FHA can begin to experience bone loss in as little as six months of amenorrhea.
Cardiovascular disease includes heart attacks, high cholesterol, and high blood pressure.
Treatment is super easy—you just have to completely shift your lifestyle, change your eating habits, and prioritize stress management 😂.
In all seriousness, hypothalamic amenorrhea is absolutely treatable—you can get your menstrual cycle back. Keep in mind that factors like your age, weight, activity level, and genetics can play a role in how long it takes for your period to come back.
In general, it will take six to twelve months of consistent treatment to begin menstruating again.
Read on to discover my top four tips to get your hormones back in balance, and recover your menstrual cycle!
As a functional nutritionist, nutrition is always the number one focus in any of my health improvement plans. Women who aren’t having regular periods tend to be some of the fastest responders to a tailored nutrition and supplement program, primarily because the loss of menstruation is often a sign of underlying nutrient deficiencies. Even when eating a whole-foods diet, many nutrients can be inadequate if a concerted effort isn’t made to include specific foods and/or supplements.
While there are likely dozens of nutrients that are important in regaining regular monthly cycles, there are a few in particular that I find to be extremely effective in helping to restore the menstrual cycle.
Zinc
Zinc is a critical nutrient to consider, and it’s recommended to increase zinc intake when struggling with loss of menstruation.
Foods with high zinc content include shellfish like oysters and clams, red meat, pumpkin seeds, and poultry, but often it can be difficult to get adequate zinc without additional supplementation, even in the context of a whole-foods diet.
I recommend 30 mg of zinc per day for someone struggling with amenorrhea. Make sure to always take zinc with a meal to avoid nausea.
Magnesium
While I feel that everyone can benefit from daily magnesium supplementation, it’s especially important for those looking to get their menstrual cycles back to supplement with magnesium.
Magnesium is difficult to obtain in our modern diets due to food processing techniques and soil depletion. I recommend 200 to 400 mg per day of a chelated form of magnesium to supplement your food sources.
Vitamin B6
Finally, vitamin B6 is another nutrient that is not often discussed but can be very helpful in restoring menstrual function. One type of amenorrhea caused by high prolactin levels was able to be treated using B6 supplementation, suggesting that supplementing with B6 may be beneficial. Vitamin B6 is also helpful in improving progesterone levels which is essential to restoring monthly cycles.
Other nutrients
One nutrient that I find to be quite low in many of my female clients’ diets is vitamin A. Aim to eat four to eight ounces of beef or lamb liver every week, which will provide plenty of vitamin A. If liver isn’t your jam, be sure to supplement with additional vitamin A.
Another important nutrient is vitamin D, which typically comes from adequate sun exposure, but can be helpful as a supplement for those with blood levels below 30 ng/mL.
In our modern world of late-night TV, attachment to our cell phones, 24-hour artificial light, and inadequate hours of sleep, our circadian rhythms have taken a serious beating.
Following roughly a 24-hour cycle, circadian rhythms affect all endocrine hormone secretions, including melatonin, cortisol, thyroid-stimulating hormone, growth hormone, prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin, leptin, and more. While we don’t know how all of these hormones might contribute to healthy menstruation, we do know that prolactin, FSH, and LH are the key hormones regulating the menstrual cycle along with estrogen and progesterone.
We can assume that if these hormones aren’t being released at the appropriate times, the reproductive system won’t be getting the proper signals that are needed to regulate the menstrual cycle. And some research does show that circadian rhythm disruption from sleep disturbances can wreak havoc on women’s reproductive function.
There are dozens of factors that affect circadian rhythms, but I’m going to focus on the two most important: light exposure and sleep.
Proper light exposure includes getting adequate daytime sunlight and appropriate elimination of bright light at night. The biggest influence is the light hitting the eyes, so I recommend getting outside, or at least sitting by a window, for most of the daylight hours. In addition, limiting blue light exposure once the sun has gone down is also important.
And, of course, it should go without saying that sleep must be a priority. It is imperative to get a full eight-ten hours of deep, restorative sleep every night, even if it requires significant changes in lifestyle or daily routines.
Read more: 10 Tips to Get a Better Sleep Tonight.
This is a tough one for a lot of my clients. Do carbs and calories make you gain weight?
Yes.
Are you missing your period because you’re under-nourishing your body, and probably underweight?
Also yes.
It’s a well-known phenomenon in the medical world, called the female athlete triad, where women undereat and overtrain so much that they lose their menstrual function, and even put themselves at risk for osteoporosis.
Many women face hormonal imbalances if they are overly restrictive with food intake, and I’ve worked with many clients who have lost their menstrual function after switching to a low-carb or low-calorie diet. Women often get stuck in an overly restrictive, low-carbohydrate approach that does not support healthy endocrine function through various effects on the hypothalamus– pituitary–adrenal (HPA) axis and thyroid hormone conversion.
Evaluate how restrictive your diet is to ensure you’re getting enough calories and carbohydrates to support your activity levels. I generally recommend at least 30 to 40 percent of calories from carbohydrates for my clients who aren’t getting their period. Estrogen and leptin are both produced by fat cells; if too much weight is lost, a woman’s body can cease ovulating because it senses the lower levels and thinks it is starving. Trying to quickly lose weight while dealing with amenorrhea is rarely a good combination.
A major issue with amenorrhea is overtraining, which I see in many of my female clients trying to “lean out.” As I mentioned, this overtraining and undereating combination is known as the female athlete triad and is well known as a cause of amenorrhea. Overtraining means different things to different people; what might be a normal training schedule for an elite athlete may cause burnout and hormonal disruption in a non-athlete.
If you’re not having a menstrual cycle (amenorrhea), take a good look at your training regimen to make sure that you’re not overdoing it. A good idea is to cut your training in half for 2-3 months and see if your cycle returns.
This is another big issue for women experiencing amenorrhea. Stress is generally unavoidable in our modern lives, but that doesn’t mean it should disrupt hormone regulation.
Chronic stress causes hypothalamic–pituitary–adrenal (HPA) axis dysregulation, which is also known as “adrenal fatigue.” Unfortunately, the hypothalamus and pituitary glands are also key regulators of the menstrual cycle. Thus, chronic stress is easily able to cause irregular menstrual cycle activity and can even lead to amenorrhea. This is very similar to what happens in the case of the female athlete triad and is typically caused by the chronic physical and/or emotional stress that is unfortunately common among women.
For those trying to overcome amenorrhea, getting stress under control is very important. This includes the recommendation above regarding eating enough and avoiding overtraining, but it also deals with managing daily stress from work, relationships, financial issues, and more.
Find a stress management protocol that works for you, which can include yoga, meditation, journaling, deep breathing, and more. Anything you enjoy doing that helps relieve stress is a great choice and can make a big difference in helping your normal menstrual function to return.
Reach out, let’s get a 1:1 consultation scheduled, and we can dig deep into the root cause of your amenorrhea.
These are my best general recommendations for how to restore your period, and I’ve used these strategies successfully time and again with many female clients. It’s important to address all these factors, as any one of them can be enough to disrupt menstrual function, which is a sign of suboptimal health.
Of course, sometimes this isn’t enough to get you back on track hormonally, and you may need some additional testing to identify any issues that may be causing the amenorrhea. I’m a big proponent of comprehensive hormone testing so we can get an idea of where baseline hormone levels are currently at. This can help to guide specific treatment recommendations and hormone support.
A specific hormone condition that is a common cause of missed periods is Polycystic ovary syndrome (PCOS). PCOS can significantly disrupt hormonal function and will require further exploration. Read more: Polycystic Ovary Syndrome PCOS) and your fertility.
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Sarah Jane Sandy is a certified nutrition therapist, and a fertility and women’s health expert. She has helped hundreds of women increase their fertility naturally and go on to have healthy full-term pregnancies. She has been working with women and couples trying to get pregnant for over 16 years and over 90% of the women who work with her get pregnant and have healthy babies.
She also works with women trying to fix their hormone imbalances, as well as supporting women through pregnancy and the postpartum period. Learn more about her own fertility and hormone journey here. To send Sarah a message, complete her Contact Form.
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