If you’ve lost your period due to intense training or weight loss, you’re not alone. Functional Hypothalamic Amenorrhea (FHA) is common among athletes and those with low energy availability—but just because it’s common doesn’t mean it’s normal or without consequences.
What Is FHA and Why Does It Happen?
FHA typically results from low energy availability (LEA)—when your body doesn’t get enough fuel to support both daily functions and physical activity. This can happen at any body size and isn’t just about being underweight. Contributing factors include:
- High volumes of exercise
- Fasting or skipping meals
- Low-carbohydrate diets
- Psychological stress
- Genetic predisposition
While the absence of periods is the most visible sign, FHA also affects other hormonal systems, including the thyroid, adrenal glands, and growth hormone axis.
How Is FHA Treated?
The cornerstone of treatment is restoring energy balance—increasing food intake and, when needed, reducing physical activity. But vague advice like “just eat more” can leave people feeling lost. That’s why I’ve developed some practical guidelines to help patients take actionable steps:
- Always eat a snack with at least 15g of carbohydrates before exercise—no fasted training.
- Eat three balanced meals a day, with at least half of each plate made up of carbohydrates.
- Include a 15g carbohydrate snack between meals to maintain energy levels.
This can feel uncomfortable at first, especially if you’re not used to eating this much or are reintroducing foods you’ve previously avoided. But trust the process—your body needs this energy to function properly.
What to Expect During Recovery
Recovery isn’t instant. It can take months for menstrual cycles to return. I call this the “patience phase.” During this time, I monitor key markers like:
- LH, FSH, and oestradiol (to track hormonal recovery)
- Iron levels and free T3 (to assess energy availability)
An increase in vaginal discharge, improved energy, and better mood are all encouraging signs that your body is healing.
Mental Health and Movement
I never recommend cutting out all exercise—movement is important for mental health. Instead, I suggest gradually reducing training volume and adding rest days, especially if periods don’t return despite nutritional improvements.
Sometimes, working with a psychologist or dietitian can be incredibly helpful, especially if food fears or body image concerns are part of the picture.