195. Hypothalamic Amenorrhea: What You Need To Know + Menstrual Cycle 101

ESSENTIAL EPISODE! In this episode I do a grand review of Hypothalamic Amenorrhea (HA): I discuss the female menstrual cycle, what causes HA to occur, why it's detrimental to have and how to recover your cycle. Save, send and come back to. 

Transcript

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Hey everybody and welcome back to the Night Fit Podcast. Super excited to have you guys here today. Today is going to be very dense. We're going to talk all about missing periods, aka hypothalamic, amenorrhea. We're going to dive in, talk about the science, why it happens in your body, what it causes when it happens, and how you can reverse it. I know I have quite a lot of listeners who are interested in this topic, maybe people who have been through it, who are living in it. Maybe you know a friend or a family member who you think is experiencing this. And I've done episodes similar to this in the past, but it's been a long time since I really did a deep dive into it. Um and I just thought, why not just do a refresher, right? Why not do another one so that people have a more up-to-date episode that dives into this? And why is this topic so important? Safe to say, um, that term doesn't even apply here, safe to say, but I mean it kind of does. I've been through it. I have been through a missing period or I had hypothalamic amenorrhea. I had it back in 2023, um, 2024, kind of, and I have been through healing my body of it. I know what it does, I know the detriments of it, I know what it's like to live with it, I know what it's like to heal from it. I've been there. My feet have been in that position, and it's really challenging. It's also very confusing. And doctors don't always have the right answers or know how to help or give you the correct diagnosis. It's really complex. So that's what we're gonna talk about today. So if you're here for that, welcome. Excited to have you just to set the scene as I always do. Lainey is taking her first nap of the day. It's 8 20 right now. Um, God willing, I get through the majority of this episode before she wakes up. This first nap is usually about an hour long and she fell asleep probably 10 minutes ago. So we'll see. Um, this is definitely a meaty one, so maybe we'll just make our way through it in chunks, but you guys won't know. It'll appear seamless to you. Um, I'm drinking coffee. I am, it's got a bunch of it's an adorable mug. My sister got it for me. It's got a bunch of photos of Lainey's face on it, just all over the mug. It's so cute. Um, and I went for a jog this morning, about five-mile jog. I guess it's a run, five-mile run, kept it super easy. Just was kind of in a state of whimsy and awe. I was looking up at the clouds. There was a storm that happened overnight, and so I love like the ambiance after a storm. It was cool, the air was um honestly kind of humid, but the clouds were kind of gray, but moving away. There were puffy clouds. I was looking up at the sun that was peeking through. I just felt really in touch with God. And I came back to the house, and Laney was um, my husband is a gem. He did his workout early this morning, and then he I pumped my breast milk, and then he fed Lainey while I went on my jog. And um, I got back to the house and they were sitting on the front stoop. It was so cute. We got to spend some time just sit out outside our front front door and just be together. Um, I love her so much. It is physically painful, and that's I think that's also part of what fires me up even more about this topic is I wouldn't have her had I not healed myself, right? And I know there's a lot of women out there who want to be moms, want to be mothers, want to get pregnant or trying to conceive, but are also struggling with hypothalamic amenorrhea. And yeah, so that's kind of the scene right now. And we're just gonna dive in and get into the nitty-gritty of it. So I want to start out before we even talk about hypothalamic amenorrhea, I think it's important to talk about the female menstrual cycle, right? And there's a lot of people out there who are going through life not even understanding their own body or their own menstrual cycle. And if you have a regular cycle, one, kudos. Two, you should probably still understand the health of it and how it functions, how it works. Because your menstrual cycle truly is your vital sign. If you don't have it, that's a sign that something is wrong. Whether or not it's HA specifically, if you don't have your cycle, something is wrong. So that's what we're gonna kind of talk about today is what could be wrong. But understanding the cycle is important first. So, very high level, every month one of your ovaries releases an egg that's called ovulation. And at the same time that that's happening, hormonal changes are occurring across your body that prepare the uterus for a potential pregnancy. And there's this very important hormone called gonodotropin, or GRH, as we'll refer to it, and that is sent from the hypothalamus to the pituitary gland. So, and we're gonna talk a little bit about those definitions, but it's just important to know that there's this important home hormone called GRH that travels from your hypothalamus to your pituitary, and that's a really important thing that has to happen in order for you to ovulate every month, and ovulation is critical. So, the hypothalamus, just to dive into what even is the hypothalamus and the pituitary, the hypothalamus is a brain region that acts as a coordinator, if you will, and it receives information from various brain areas and assesses the body's internal state. The hypothalamus also releases hormones that either directly affect other parts of the body or signal other glands to release their own hormones. So the hypothalamus is really important when it comes to hormone releasing, assessing the body's state and things like that. Then you have your pituitary gland, and this gland is connected to the hypothalamus and stores the hormones produced by the hypothalamus. It releases those hormones into the bloodstream, which then travels, which then travel to target organs and tissues throughout the body. So, and that's essential for your cycle to function. So if you think about the hypothalamus, it makes these hormones, sends them to the pituitary, the pituitary stores them and then sends them out on their way to cause action in your body, specifically to cause action in your ovaries, aka ovulation. And so your cycle begins with your hypothalamus creating GRH or gonadotropin, sending it to the pituitary, the pituitary stores it. And then what does it do? It releases two important hormones: follicle stimulating hormone, FSH, and lutinizing hormone, LH. Those two hormones travel down to the gonads in your ovaries. Once they get there, they communicate with the gonads, and the gonads create estrogen and progesterone. And that's what we call the HPG axis. And the G is for gonads in the ovaries. And so that communication between the hypothalamus, the pituitary, starting with that GRH in the initial communication, then the FSH and LH down to the gonads, and then then estrogen and progesterone, that whole process is so important and it needs to happen every single month. And what happens then is once we have that FSH and LH traveling down, creating the estrogen and progesterone in the gonads, that stimulates ovulation. And if ovulation takes place and the egg is not fertilized, the lining of the uterus sheds through the vagina, and that's what we call your period, right? And so every single month you have this hormonal communication happening. And it's really in-depth and very interesting. And a lot of times people think, you know, every month they're just bleeding, shedding is happening, but it's really pretty miraculous what's going on within your body. Your body is attempting to allow for pregnancy, and the shedding is the lining of your uterus where that egg was coming out of you. So it's pretty, pretty beautiful. And we talked about the HPG axis. I also want to talk about the HPA axis. So the HPA axis is what we call the hypothalamus, which you're familiar with, the pituitary and the adrenal glands. So you have something over here, you have the HPG, which is hypothalamus, pituitary gonads. But you can also have other axises, axes, I should say, such as the HPA axis. And like I mentioned, that includes the adrenal glands. And the adrenal glands are important when it comes to your body's stress response. And when your body is worked up and stressed, this signals your adrenal glands to create cortisol. And that system really helps your body in a stress situation, in a flight or fight situation, in a we need to act now situation. And these two different axes are important because one of them stimulates your body to reproduce. And the other, which can be overactive, your HPA axis, stimulates stress and it stimulates your body's response to stress and how your body's reacting to stress and how your body perceives your situation. And so both of these are important. But we'll come back to the HPA axis as far as how it applies to hypothalamic amenorrhea. But it's a very important axis to understand because your body, when you have HA, your hypothalamic pituitary axis is a bit overstressed and overstimulated. And so we'll talk more about that. But now I want to break down your cycle because as I mentioned, understanding your cycle is important, but we know that we ovulate every month. But what does a healthy cycle look like? You know, when should we ovulate? How long should our cycle be? So your cycle is split into three distinct phases. You have your follicular phase, ovulation, and your luteal phase. And I want to keep this really high level for you guys because getting tuned to the weeds, especially for listeners who already know, but getting too into the weeds, there's more questions that can arise. So a healthy cycle in total should be 28 to 35 days with a little bit of variance there because every woman is different. The front half of the cycle is the follicular phase, and that's 14 days on average. The follicular phase starts with your period, your or menses, and that's about three to seven days long. The follicular phase is characterized as the low hormone phase, and that's when estrogen, progesterone, LH or luteinizing hormone, and FSH follicle stimulating hormone are low. In the later follicular phase, around day five to six, and that's when your your period, your bleeding begins to subside, one dominant follicle in the ovary begins to mature, producing increasing levels of FSH and estrogen, which causes the uterine lining to thicken and rebuild. Estrogen peaks around the start of ovulation, which is typically day 14 to 16. Then, when healthy and regular, ovulation occurs and lasts 12 to 36 hours on average. During ovulation, the mature egg is released from the ovary. Estrogen levels peak just before ovulation. This triggers a surge in luteinizing hormone, which causes the follicle to rupture and release the egg. And so a lot of women track that LH or that luteinizing hormone surge to see if ovulation is impending or about to occur. Then on day 15-16, the luteophase begins and lasts for an average of 14 days, 12 to 14. The luteophase is characterized as the high hormone phase as both progesterone and estrogen rise together. And during this phase, the rise in progesterone and estrogen prepares the uterus for the potentially fertilized egg, aka pregnancy. If the egg is not fertilized, progesterone and estrogen drop, causing the shedding of your lining in the end of your cycle, or if you think of it, the start of your next cycle. Because, like I said, bleeding is the start of your cycle. So during all these changes, um, how we store glycogen, our energy level, mood, desire to train, sleep, our ability to get pregnant, our outlook, and everything is impacted. And that's why we hear a lot about women being affected by their cycle. Think about the fluctuation in hormones. It's pretty dramatic throughout your cycle. But I do think it's important for women to understand their cycle, to understand that shift in hormones over time, to understand if they're ovulating appropriately. Are they even ovulating? Is LH spiking? Are do they have a healthy length follicular phase, aka 14 to 16 days? Do they have a healthy length luteal phase? 12 to 14 days. And all these things signal whether or not your body is doing things appropriately, or if something else might be wrong. A lot of women struggle with really long follicular phases, so the front half of your cycle leading up to ovulation, and that can be caused by disruptions of your HPA axis, stress, not eating enough, things like that. Your estrogen is just not able to surge as intensely as it should soon enough. And then a lot of women struggle with short luteal phases, which means that their progesterone level, which is particularly important for implantation, is struggling to get high enough to keep their luteophase long enough. And so it's it's critical for you to understand and know your cycle, the length of it, if it's healthy, if you're ovulating, and all those things. So hopefully breaking that down gave you some insight into yours into your body, yourself, talking a little bit about the HPG axis, touching briefly on the HPA axis, which we'll touch more on in a little bit, and just gave you a high-level understanding. But now let's dive into hypothalamic amenorrhea. Why do we lose our cycle? What happens in the body, right? So we're gonna talk about a few things: energy balance, leptin, the deficit effect, and stress. And understanding these four things will help you understand if this might be happening to you and what you can do about it. And once we talk about those factors, we're gonna talk about why HA matters, why it matters if you have this happening to your body. We're gonna talk about the impacts on your body, what you might be experiencing, and then we're gonna talk about recovering. Okay, so we're gonna start with the role of energy balance. A woman's body is extremely sensitive to energy fluctuations. And when a woman is eating a restricted diet or just not eating enough, or if she's fasting or skipping meals, she's exercising strenuously for hours a day, things like that, her body recognizes this negative energy balance as a threat to her survival. And this triggers an imbalance of the HPA axis. Ding ding-ding, what we talked about earlier. So that HPA axis is stressed out, it's pumping cortisol into your body at high amounts, your body thinks something is seriously wrong. And so, because the HPA axis is overstimulated, it shuts down non-essential body processes such as reproduction. And in short, a woman becomes infertile, and this is what we call hypothalamic amenorrhea. So that's the role of energy balance. When you're underfed and your body perceives this as stress, it causes the HPA axis to go haywire, and your body perceives this as an inability to properly reproduce, shuts down your reproductive system, and you become hypothalamic amenorrhec. Let's talk about the role of leptin. This is also important. So your body fat produces leptin. And so this is why your body fat percentage is important when it comes to the discussion of HA. When a child gains enough weight, as an example, there's a threshold amount of leptin produced to signal the hypothalamus to kick off their first menstrual cycle. So that communication between the hypothalamus, pituitary, down to the gonads. And the opposite is true for women who get too lean or who restrict calories too much. So they lose too much body fat and their leptin levels plummet. So getting too lean decreases the amount of leptin circulating in the body. And this in turn decreases the activity of the hypothalamus. So this is very true that every woman needs enough body fat and enough leptin to reproduce. And that's why it's critical to not get so lean that your body doesn't have enough leptin. The next topic is the deficit effect. And as discussed, women's physiological sensors are highly tuned in to sensing deficits. And whether in energy balance, essential nutrients, or body fat, women's bodies quickly respond to what they perceive as deficiencies. And the deficit set point will vary from woman to woman. Some women can be naturally leaner, can work out at really high volumes and intensities, or eat fewer calories and stay hormonally healthy. Other women are much more sensitive to perceived restriction or stress. And so understanding that the deficit effect is unique to each woman is critical because it can help you understand yourself and also not fall into the comparison trap. So how sensitive your body is to deficits is what we call the deficit effect. And the last topic to discuss is stress. So not only is it about nutrient deficiencies and energy balance, having enough body fat and leptin, your personal deficit effect, but stress. When our body senses stress, it doesn't know one cause from another. Any stressor signals that the body needs to be ready for fight or flight. And this can shut down your reproductive system all by itself. This is another HPA axis trigger, if you will. And some potential stressors that you might have going on in your life include too much stimulation, maybe from caffeine, if we're not calm enough and we don't recover often or deeply enough after training or just intense life events. It's really important that our parasympathetic nervous system, which is the calming system, can help you rest, recover, and digest. It's really important that that system kicks on enough and frequently enough for you to be in a calm state. If you're constantly self-critical or maybe a type A personality, control freak, perfectionist, all these things, aka I relate to this. If that's you, you might be a little more baseline stressed than you know you are. If you're not sleeping enough, we all know that when we don't sleep enough, we tend to feel a bit more anxious, stressed. That's because our HPA axis triggers more cortisol production when we're not sleeping quite enough regularly. If we skip meals or fast too restrictively or too often, that actually amps up our stress hormone production. It makes cortisol rise. There's a reason fasting causes people to over time kind of adapt to that fast, or the longer you fast, the easier it gets. It's sometimes the case because we have cortisol pumping through our body. And so every time you dip into a fasted state, cortisol does rise. If you tend to do that often, maybe you skip lunch all the time, you go long periods without food, you're going to have more cortisol pumping through your body. Your HPA axis is going to be working harder and more frequently, aka overstimulated. If you beat the heck out of yourself too often in really high-intensity workouts, you're stressing your body out, you're putting it through a lot, that's a stress trigger as well. Maybe work requirements, things at work are stressing you out, family life, friend, relationship stress. There are so many different sources of stress. And it's important that we talk through those four topics. So energy balance, leptin, deficit effect, and stress. And think about those four things as it applies to you. But why does this matter? Why does having hypothalamic amenorrhea matter? In the case of hypothalamic amenorrhea, the messages that we talked about earlier, from the hypothalamus to the pituitary to the ovaries, that communication significantly diminishes. And that means that the production of hormones like estrogen and progesterone is dangerously reduced. Why is that a problem? Your body needs these hormones for many things. For starters, bone strength. In fact, because of the link between estrogen and progesterone. And bone health, many fit young women who lose their cycles end up with weaker bones than their 80-year-old grandmothers. Okay, we see osteoporosis, osteopenia, lifelong problems, injuries, stress fractures. These hormones are also important for your brain health, muscle function, digestive health, metabolic health, hair skin, nail health, heart health. There's actually a higher incidence of heart issues and cardiac events. They're also just required to keep you feeling healthy, energetic, and even keeled psychologically. But these are just some of the things that are impacted by a lack of proper hormone production. What might you notice if you're in a state of hypothalamic amenorrhea? You might notice fatigue and low energy, disrupted sleep, which includes trouble falling asleep, maybe waking up at 3 a.m. all the time and feeling your cortisol spike. You might notice hair loss, or for some facial hair growth, cold hands and feet, which kind of goes with that excess hair growth. Your body's very cold, skin problems like dry skin or acne, weight changes and changes to where you put on body fat, maybe more around your middle, slow injury healing, more inflammation, anxiety, OCD, low self-esteem, and or depression. There's a reason we have more mental health issues in a state of hypothalamic ammonarrhea, anemia, orthostatic hypotension, electrolyte irregularities, vaginal dryness or thinning of tissues, painful sex, low libido, bradycardia, chronic pain, changes in digestion, also things like SIBO or chronic digestive issues, so many negative things. And the list goes on. Essentially, you will not feel like yourself. And things physically, mentally, emotionally will all be shifted in the negative direction. I also want to put a disclaimer out there that sometimes it's not hypothalamic amenorrhea that you have. If none of these symptoms apply to you, you're eating enough, you're not overtraining, those four topics we discussed don't apply to you, whether it's the deficit effect, energy balance, things like that. It's important to go into your doctor and make sure you don't have other conditions going on that are causing you to not have your cycle. Just to list a few things that could be going on that could cause amenorrhea, which hypothalamic amenorrhea is the state of your HPA axis causing this issue. There's also just amenorrhea in and of itself, which is a missing cycle for three plus months. Things like PCOS or polycystic ovary disease can cause this, thyroid problems, uterine scarring, pituitary tumors, endometriosis, premature menopause. There's other things that can cause amenorrhea by itself. So it's worth it if you don't think you this applies to you to look into that. But I will say there are many women misdiagnosed with PCOS or other conditions who actually just have HA. So it also requires you to look acutely at your own behavior, be honest with yourself, see if you're eating enough, if you are overtraining, if you're properly taking care of yourself, how stress is impacting your life, and many different areas like that. And just be completely honest with yourself. Okay, so let's we've talked about HA and what causes it in the body and why it's important to talk about. Okay, you guys, we made it to the last section, and that is how to recover. So the first step is to get diagnosed, get help, figure out what's going on. So get your blood lapse done, have an action plan. I highly recommend working with a naturopath or someone who can look at your hormones, see how they're functioning, especially if this seems like a state you've been in for a while. I say a naturopath because I didn't have the best experience with an OBGYN. They don't know as much about the specific condition, at least in my experience that was the case. So highly encourage working with someone who wants to dive into your hormone health specifically, get this looked at, tell them what you think is going on, advocate for yourself. You'll want to look for low estrogen, low FSH, low LH, low progesterone, things like that, just low hormone levels. But also you'll want to use their guidance and expertise when it comes to getting this diagnosed. Then you'll want to come up with an action plan. Understand and address the root issues. Are you fueling enough? Are you overtraining? Is your sleep out of whacked? Are you overly stressed? Figure out what you think inherently you might be doing that is causing you to be in this state. So then you're going to start by doing the right things. First and foremost, eating more food. If you think back on the four topics we discussed: energy balance, leptin, the deficit effect, and how it impacts you personally, and stress, a huge part of that is that you're underfueled. And if you have HA, you get diagnosed, you realize this is something that you're doing, even unintentionally in some circumstances, the key is to fuel your body more. There's this kind of lingering, floating around rule about 2,500 calories, and that it's magic, and that if you eat 2,500 calories, no matter what your movement is or your lifestyle, you're gonna get your cycle back. And I hate to be the bearer of bad news, but that is not necessarily true. Oftentimes women need way more calories than that to restore their cycle. So the key rule of thumb here is to fuel properly, regularly, and often, and at decently large quantities throughout the day. Really focusing on high-quality micro-nutrient-dense meals because if you have HA, your body perceives that you're living in a deficit state and it needs to be fueled and reminded that you're not. And so it becomes crucial to fuel often. So you have your three regular breakfast, lunch, and dinner, as well as snacks between those meals. We're not going long periods without food. So when you wake up in the morning, have a large breakfast. A large breakfast has also been very effective for people who are trying to heal their body. Wake up, eat a nutrient-dense breakfast, go about your day, have a mid-morning snack, have a large lunch, have an afternoon snack, have a large dinner. Fuel your body. A lot of people who have HA also tend to lack in the carbohydrate and healthy fats department. We become protein obsessed, they're very lean, that tends to be something that coincides with that. When we're chasing leanness, we focus a lot on protein and neglect the other sources of fuel that our body needs, specifically carbs and fats, which play a critical role in reassuring our brain with that hypothalamus and pituitary, and our body that we have the energy we need. That's why carbohydrates and fats are so critical. Carbs are our main energy source and what our body looks to to see that we have enough energy. That's why it's essential. And healthy fats play a role in hormone production as well as brain function. And so those two categories together, those macronutrients, need to be re-implemented in full force into your diet at every meal and throughout the day. You don't need to be hyper-obsessive about it. Just make sure you have carbs and fats at every meal. Some good ideas are avocado, olive oil, yogurt, fatty fish, get those omega-3s in, and then the carbohydrate sources. You guys know what to do. Pasta, breads, fig bars. I personally love nature's bakery bars. Just regular snacks that you probably neglected for a long time, bring those back into your life. So eating more is critical. As far as the 2500, to circle back to that, is it magic? No. Should you track calories? In my opinion, no. It's much more essential that you just regularly consume food throughout the day, focus on satisfying yourself. And if you're someone who has somewhat lost your appetite in this process, it'll be essential for you to be more intentional about having regular meals and snacks. And if you're someone who becomes extremely hungry, I personally experienced extreme hunger when I was going through recovery. You need to lean into that and fuel yourself and listen to your body. Your body is going to want to adapt to this new intake, so allow it to do so. If you are still physically active, and we're going to next talk about exercise, that caloric number will need to be even higher. Now, when it comes to exercise, you're going to want to modify that. If you are training hard, if you're working out, doing a lot of cardio at high intensities, running a ton, things like that, you're going to want to drop that down. Focus on low impact movement. Focus on keeping your heart rate lower. The reason I say that is that high intensity exercise and specifically cardio has been shown to elevate cortisol and stress the body. And at this time, what your body needs is extra reassurance that you are not in a stressed, deficit, chronically overdriven state. It needs reassurance that you can relax, that you're okay, that you can reproduce. This is temporary. My advice is to drop down your training level. I'm not going to prescribe specific amounts. What I will say is that the more you lean into relaxing and letting your body recover, the faster you will personally recover. However, I also know it is very hard to completely cut exercise. That isn't my advice. In my own experience, that isn't what I did. I didn't do the quote unquote all-in approach. I just modified my exercise to focus on what was fruitful for my body. I did walking, stretching, very light lifting. I actually cut out running myself, and it that was very effective. I just focused on movement for the time being that was beneficial when it comes to putting my body into a replenished state. I wanted to get as far out of a deficit state and a stress state as I could. So I modified my exercise to match that desire. And that is my advice. I also have plenty of interviews on this podcast with women who recovered their cycle while implementing some exercise. Definitely check those out in the period recovery guide in the show notes. Listen to those interviews. It is possible to maintain an exercise level and recover. That said, if you do maintain some exercise, you're going to want to be even more intentional when it comes to the fueling and to circle back to that. You'll want to always eat before you train, intra-fuel as needed, especially for sessions over 60 minutes, and always refuel immediately post-exercise. Kind of cushioning, if you will, that training will be to your benefit and will be so much more helpful when it comes to reassuring your body. Especially if you're someone who cannot sacrifice your training, let's say you're an athlete or something like that, then you'll need to be even more intentional with how you feel your body around training. Another tip is to rest and sleep more. Yes, it's true. The less you do physically and the more you eat, the faster you will likely recover. I don't think that's a great strategy to do nothing and eat a ton for everybody because it's not sustainable when you're trying to live life again post-recovery. So I just suggest take more rest days, sleep seven to eight to nine hours, whatever your best window is, whatever feels best for you, but get plenty of rest and sleep in. It is sleep that is rejuvenating. It is sleep that allows our body to produce hormones in the first place, to ovulate successfully. It's critical. So if you've been shirking in the sleep department, highly encourage you to refigure that out. Make sure you have enough rest days, two to three a week. Um, that's not a prescription, that's just advice. And just give your body more downtime throughout the day. Lean into that. De stress. So if you we talked about all the different stress triggers earlier, if many of those things really hit home with you, find ways to grasp that and control it and maybe make some changes in your life. Consider less caffeine. Caffeine is a stimulant, it causes stress in the HPA axis, it really does cause adrenaline and things like that. So just be cognizant of how much caffeine you're consuming, maybe how you time it throughout the day. And my last piece of advice around recovery, you guys, is tracking recovery symptoms. And why do I say this? Because when you are in control of the process and you're aware of when you're actually making progress, it could be one, very encouraging and motivating, but two also help you know if you're making the right changes and if you're making enough changes. There was an ad for a NITO fertility monitor. Highly recommend that investment helps you see your hormone levels from home. Other signs of recovery to track are cervical mucus. Cervical mucus is a sign that your body is producing estrogen. And so seeing that regularly, especially a change in different consistencies of the mucus, is a sign that your body is creating hormones again. Breast tenderness, that's a progesterone symptom, also estrogen, a higher basal body temperature. So if you wear an aura ring or you just simply test with a thermometer in your bed, this is a great way to see if your body is warm enough and your metabolism is functioning properly. When women have HA, they tend to have a lower basal body temperature in the 96s, if we're speaking about Fahrenheit. We want to look into the 97s, mid-97s for a healthy basal body temperature, healthier hair, skin, and nails, weight gain, and I didn't prescribe that as a way to recover, but it often is helpful in the recovery process. As you fuel your body more appropriately, weight gain tends to be a symptom. It can be temporary or it can be something you truly need, but it is often a sign that you're doing the right thing. There's a lot of underweight women with HA. That said, there's also a lot of women who are not underweight and still need to gain weight in order to get their cycle back because they begin fueling properly. And with that, their metabolism will readjust to that intake over time and their body composition can change, but weight gain often is a great thing to better sleep, less crazy hunger, or more hunger. Both of them can be signs of recovery. So let's say you had extreme hunger to begin with, that might become more neutral. And let's say you had a very slow appetite, now it might be stronger, which is a sign that you're eating more, which is good. So both of those things, depending on your baseline, are positive. Like I mentioned, an improved metabolism. So maybe that body composition, you gained weight, now it's kind of leveling out, things feel good because you're eating more and your body's reacting and adjusting to that. Because when you're under-eating, your metabolism does its best to match your intake and will slow down. So now you're you'll see an improvement in metabolism, more energy, better libido, all kinds of things. So those are just some symptoms of recovery that are worth you personally tracking and just being aware of. If you write it down, put it in an ETO app, anything like that. So yeah. So you guys, we covered a whole host of topics today. We started with a high-level review of the menstrual cycle, talking about the HPG and HPA axis. We then talked about the menstrual cycle as a whole and kind of broke it down. We talked about the four areas to focus on when it comes to how do we lose our cycle and develop HA, which are energy balance, leptin, deficit effect, and stress. We talked about why hypothalamic amenorrhea matters and the symptoms and what might happen to you if you're living with it. And then we talked about recovery at a high level and some things you can do to begin making progress. I hope you guys enjoyed this episode today. I think HA is something that is sadly very common, not addressed enough, not spoken about enough, but we are doing the good work to make it more well known and for women to become more aware of what underfueling and living in a chronically malnourished state can do to your body. Living without your period is not healthy, it's not normal, and you shouldn't have to do it. So I hope this was helpful. If you know someone who needs to hear it, please send it. As mentioned at the front of the episode, if you wouldn't mind rating the podcast as well as giving us a follow, we appreciate it. Thank you guys and have a great rest of your day.