Lost your period from training? Care for hypothalamic amenorrhea and REDs in Calgary
If your period has gone missing since you started training harder, running more, or eating "cleaner," you've probably heard one of two things: it's normal for athletes, or you need to stop exercising. Neither is the full story.
A missing period is a signal that your body doesn't have enough energy for everything you're asking of it. It's common, it's treatable, and in many cases you don't have to give up your sport to fix it.
I'm Dr. Madison Thorne, a naturopathic doctor and kinesiologist in Calgary. I work with runners, triathletes, cyclists, lifters and other active women to get their cycles back, protect their bones, and keep training.
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Hypothalamic amenorrhea (HA), also called functional hypothalamic amenorrhea, happens when the part of your brain that runs your cycle turns its signal down. Without that signal, your ovaries don't get the message to ovulate. Estrogen stays low and your period stops.
It's usually diagnosed when your period has been missing for three months or more and other causes have been ruled out.
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REDs stands for relative energy deficiency in sport. It describes what happens across your whole body when you're not taking in enough energy to cover both your training and everything else your body needs to do.
A missing period is one of the most visible signs. But low energy availability also affects your bones, metabolism, immune system, mood, gut and performance. HA is often the first thing that tells you REDs is happening.
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No period for three months or more, or cycles that have become long and unpredictable
Your period stopped or changed after a bigger training block, a race build, or a change in how you eat
A stress fracture or bone stress injury
Feeling cold, tired, or flat in training even though you're doing everything "right"
Poor sleep, low libido, or mood changes
Performance that has stalled or slipped
You're trying to get pregnant and aren't ovulating
How it works:
A thorough assessment. We go through your cycle history, training load, fuelling, sleep, stress, and injury history, including any bone stress injuries.
The right lab work, not every lab. That usually means hormones like LH, FSH, estradiol, testosterone and prolactin, plus thyroid and a pregnancy test to rule out other causes. A bone density scan through your family doctor is added when it's indicated. Here's what lab work you actually need.
A fuelling plan built around your training. Food first and practical, timed around your sessions. Not a generic meal plan that ignores your schedule.
Training that supports recovery. With a background in kinesiology, I can help you adjust training load, and build in resistance training to support recovery and injury prevention.
Bone protection. Nutrients like calcium and vitamin D where needed, and working with your physician when hormone therapy is worth discussing.
Tracking your return. We watch for returning cycles and signs of ovulation, and recheck labs when it's useful.
FAQ
How long does it take to get my period back?
It varies a lot. Some women see a cycle return within a few months of closing the energy gap. For others, especially after years without a period, it takes longer.
Can I get pregnant with hypothalamic amenorrhea?
With HA you usually aren't ovulating, which makes conception unlikely until ovulation returns. Restoring energy availability is often enough for ovulation to come back. If it isn't, there are medical fertility options, and I work alongside your fertility clinic.
I'm not underweight. Can I still have HA?
Yes. HA is driven by low energy availability, not body weight. It can happen at any size.
Will the birth control pill fix it?
The pill gives you a monthly bleed, but it doesn't restart your own cycle or fix the underlying energy deficit. It also isn't the best option for protecting bone in HA. It can be the right choice for contraception, so we look at what you need it for.
Is this only for elite athletes?
No. Most of the women I see are recreational runners, triathletes and lifters with jobs, families and busy lives. If you train and your cycle has changed, it's worth looking into.
More reading: Why female athletes lose their period · Do you need to stop running? · Missing your period isn’t just a fertility problem