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Season 4 Episode 5
Understanding Hypothalamic Amenorrhea (HA) and RED-S: Expert Insights on Missing Periods
In this insightful episode of The Flow State podcast, hosts Monica Grohne and Norah Candido sit down with Cynthia Donovan MS RDN, known on Instagram as "the period nutritionist," to discuss the complexities of hypothalamic amenorrhea (HA) and relative energy deficiency in sport (RED-S).
Understanding Hypothalamic Amenorrhea
Hypothalamic amenorrhea is characterized by the absence of menstruation due to dysfunction in the hypothalamus, the part of the brain that regulates the menstrual cycle. As Donovan explains, HA affects an estimated 1.6-2 million women in the US and 17.4 million worldwide, though these numbers likely underrepresent the true scope since many cases go undiagnosed.
The Spectrum of Period Loss
A key insight from the episode is that HA exists on a spectrum. Some women may still get regular periods but not ovulate, while others experience complete period loss. Warning signs can include:
- Absence of menstruation for 3+ months
- Short luteal phase
- Regular periods without ovulation
- High cholesterol levels
- Low heart rate
- Fatigue and brain fog
The Root Causes
The primary factors contributing to HA include:
- Low energy availability (not eating enough)
- Excessive exercise (even what seems "normal")
- Chronic stress
- Disconnection from body signals
Long-term Health Impacts
Donovan emphasizes that HA isn't just about fertility - it can have serious long-term health consequences including:
- Compromised bone health
- Cardiovascular issues
- Hormonal imbalances
- Mental health challenges
- Metabolic disruption
Recovery Journey
Recovery times vary significantly among individuals, with most of Donovan's clients seeing results within 8-10 weeks, though some may take 6 months or longer. Key components of recovery include:
- Adequate nutrition and energy intake
- Rest and exercise modification
- Mindset work around body image and food
- Community support
- Reconnecting with body signals
RED-S Connection
The episode also explores RED-S (Relative Energy Deficiency in Sport), which Donovan describes as closely related to HA but more commonly discussed in athletic communities. While similar in many ways, RED-S can affect both male and female athletes and encompasses a broader range of physiological impacts.
Taking Action
For women experiencing missing periods, Donovan recommends:
- Getting proper testing beyond just TSH
- Working with healthcare providers who understand HA
- Addressing both physical and psychological aspects of recovery
- Finding community support
- Focusing on quality of life beyond just period recovery
The episode concludes with an empowering message about viewing period loss as an opportunity to address underlying behavioral patterns and reconnect with your body's needs.
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