
We constantly hear messages about how we need to be exercising enough for health and wellness. But most of this advice is geared toward the general public—not those navigating hypothalamic amenorrhea (HA). When you’re working to restore your period, the very habits that are praised in mainstream health culture can actually stand in the way of recovery. It’s frustrating, confusing, and can feel isolating. If you’ve lost your period, you might wonder if continuing to exercise will protect your bones. While exercise is generally good for bone health, the benefits are not the same when HA is involved. In fact, continuing to exercise without addressing the root cause of HA can accelerate bone loss rather than prevent it. Let’s explore why.
What is Hypothalamic Amenorrhea?
Hypothalamic amenorrhea (HA) happens when your period stops for at least three consecutive months due to stress on the body, often caused by not eating enough, exercising too much, or experiencing high levels of psychological stress. Your brain (specifically the hypothalamus) senses that your body doesn’t have enough energy to support reproductive functions, so it reduces the production of hormones necessary for ovulation and menstruation. This can lead to low estrogen levels, which not only affects fertility but also compromises bone density over time.
How is HA Diagnosed?
Since HA is a diagnosis of exclusion, doctors first rule out other potential causes of missing periods, such as PCOS, thyroid disorders, or pregnancy. This process typically includes a medical history review, hormonal blood tests, bone density scans (DEXA), and lab work to eliminate other conditions. If no other explanation is found and signs of low energy availability are present, HA is the most likely cause.
Why Exercise Won’t Prevent Bone Loss in HA
Estrogen is Essential for Bone Strength
In the case of HA, estrogen is often too low for a menstrual cycle. Estrogen plays a critical role in bone remodeling and density. When estrogen levels drop due to HA, bones lose more density than they rebuild, making them weaker over time. This means that even if you’re lifting weights or engaging in impact-based activities, your bones can’t effectively strengthen without adequate estrogen.
Insufficient Energy Availability Impairs Bone Formation
HA is caused by insufficient energy availability meaning your body isn’t getting enough fuel to support all its functions. In response, the body prioritizes essential systems (like keeping your heart beating) over bone repair and growth. If you’re not fueling enough to match your activity level, exercise can actually contribute to further bone loss.
Higher Risk of Stress Fractures and Osteoporosis
Studies show that individuals with HA—especially athletes and those engaging in high-intensity exercise—are at a higher risk for stress fractures, osteopenia, and osteoporosis. Since the body is in a state of insufficient energy availability, it pulls nutrients from bone stores, further weakening them over time. The longer HA persists, the greater the risk of developing irreversible bone loss.
It Can Reduce Sex Hormone Formation
Exercise, especially high-intensity or prolonged workouts, triggers the release of cortisol, a stress hormone. Research supports that women with HA experience higher cortisol levels than women without HA. Cortisol suppresses sex hormone production (like estrogen and progesterone), further delaying the return of your menstrual cycle. This means that continuing to engage in high intensity or prolonged exercise can prolong the amount of time it takes to recover from HA. In addition, prolonged high cortisol can also contribute to bone loss, compounding the negative effects of low estrogen.
Common Misconceptions About HA
"If I'm not underweight, I can't have HA"
HA can occur in individuals of all body sizes and even at a weight higher than your set point weight range. This is because HA is caused by insufficient energy availability, not just low weight.
“I don’t exercise much, so I can't have HA”
"I still get a withdrawal bleed on the pill, so I don’t have HA."
"Exercise strengthens bones, so I should keep working out."
"I don’t have an eating disorder, so I don’t have HA.”
"I can’t exercise at all with HA, or again in the future”
"My labs are normal, so I don’t have HA”
"You cannot have both HA and PCOS, or another condition that affects the menstrual cycle, at the same time."
"My period isn’t missing, so i’m fueling adequately”
HA Recovery is About More Than Just Restoring Your Cycle
If you are struggling with HA, you are not alone. The best way to protect your bone density is to focus on adequate rest and nourishment. HA recovery is a process of healing and self discovery as you are able to learn more about your body’s unique needs and rebuild trust with yourself. Be patient and kind to yourself along the way, remembering that you are creating a healthier, more sustainable relationship with food, movement, and self-care. You deserve to feel fully nourished, energized, and at peace.
Looking for Additional Resources?
To learn more about HA, I recommend the book No Period. Now What? by Dr. Nicola Rinaldi, a researcher and expert on hypothalamic amenorrhea who has helped thousands of people recover their cycles through evidence-based nutrition, exercise, and mindset shifts.
Rinaldi, N. (2016). No period. Now what? A guide to regaining your cycles and improving your health. NPNW Publishing.
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