5 Stages of Grief in Hypothalamic Amenorrhea Recovery

By Hannah Meier, RD and L9P ambassador

For those who may be new around here, I am a dietitian recovering from hypothalamic amenorrhea (HA). I used to be pretty quiet about that, but ever since I decided to pursue HA recovery I’ve learned how to be less ashamed and more vocal.

Sparknotes: HA is the manifestation of a reproductive system that has been “turned off” by a woman’s body for a variety of factors related to stress. Every woman is different, but our hormonal cycles are directly tied to our body’s response to the environment. When our body processes stress day in and day out, whether from chronic calorie deprivation, sleep deprivation, trauma or mental exhaustion, our “accessory” functions get kicked out in favor of those that are designed to keep us alive. My body decided to kick out my period back in high school when I was in the thick of an eating disorder. My doctors didn’t recognize it at the time because I wasn’t underweight and didn’t meet the criteria for PCOS, so I got put on birth control and a magical (fake) period came reliably every month, keeping me comfortably in denial that anything was really wrong.

It wasn’t until I found myself deep in a (wonderful) community of female runners that I started hearing more about this whole amenorrhea thing. As more women in my circle began opening up about their missing periods, I identified with their stories and thought maybe that would explain what had been happening to me. Lo and behold, many blood tests and missing periods (after going off BC) later, I was diagnosed with HA. Thanks to the success stories of other women, I was inspired to actually do something about it.

I spent a lot of this past year resenting my eating disorder history and the fact that I developed a love for running that just so happened to dig me into an even deeper HA pit.

But really, I don’t think I would have found half as much support or even the intention to fix my body if it weren’t for my ED past or the running community I’m now a part of — a realization that has taken me over a year and a full process of grief to identify.

Lesson learned: Recovery isn’t sunshine and rainbows.

A serious case of imposter syndrome was a daily reality, and part of the reason I felt hesitant about diving head-first into a counseling practice, even though I knew life was calling me in that direction.

This whole process has been about so much more than just “getting my period back.” It has been about learning how to take care of myself, learning what my values are and how I can live a life that is in alignment with them; understanding that this is just a part of my journey and that my life as a runner is not over and that I’m not an incompetent dietitian. If anything, this journey has reignited my passion for nutrition as I deepened my understanding of body respect, intuitive eating, and how damaging diet and fitness culture can be to overall health. I’ve become even more of an advocate for health at every size, learned about weight stigma and dove into eating disorder prevention work.

It has been (and remains) a long road, but at this point, I finally can look back and realize all of the stages needed to happen as they did for me to be in the place that I am. I’m at peace now, but it wasn’t always like that.

Stage 1: Denial (not my problem!)

This was my life for a good 9 years of amenorrhea. Granted, I didn’t understand why my body lost its period in most of that time. I thought I was just broken, or that I would just deal with it later when I wanted to have a baby. Not having a period wasn’t a big deal and not something I even really considered as I got a fake one every month with birth control. When I finally did start learning more about HA after being immersed in the fitness and running world for some time, I started connecting the dots. I had restricted, lost weight, exercised excessively, been stressed, slept minimally and called it “striving for wellness.” As I began to realize that maybe I did have a problem worth fixing, it took me a long time to realize that knowing did not equal changing. Though I became an avid reader and researcher about the topics of hormonal health and missing periods, it would take some time before I actually put the knowledge into practice. I continued to run, train for a marathon and half marathon before realizing that I was kidding myself.

Stage 2: Anger (why me?)

Even though exercise wasn’t the reason I lost my period in the first place, it wasn’t helping my body get out of the low-estrogen rut it had been used to. But running and exercise had become my identity. I had trained for and completed my first marathon, loving the challenge of long-distance running and the strength I felt because of it. I was working for a fitness studio and riding the contagious endorphin high of cross training with spin classes and high intensity boot camps. I loved feeling strong, the sweet relief of showering off a layer of sweat and having a community of people who shared the same passion. I was pissed that I was confronted with having to leave this behind. It seemed impossible. I felt like exercising less meant that I had to give up my entire identity and I was absolutely terrified of gaining weight. Even still, I tried to commit. I went on my last run for three months and started replacing spin classes with yoga classes. I began to take a closer look at what I thought was a pretty solid relationship to food. I reassessed whether my food (and portion) choices were made out of fear or out of trust. (Why did I slice off only 1/4 of an avocado and gravitate towards processed protein desserts?) I got pissed at diet culture and the messages I’d internalized for years that told me to eat less and be smaller. I woke up angry that I couldn’t run and went to bed upset that I was stuck feeling like an imposter. What kind of dietitian was I if I still struggled with food and exercise? Wasn’t I supposed to have this all figured out? I was pissed that my body wasn’t working right and that I had to change the way I was doing things. I seemed fine before, had finally felt good in my body and thought I had the magical health equation figured out. Why did I have to do this hard work now?

Stage 3: Bargaining (Ok but what about this?)

As I started gaining weight and seeing my body change before my eyes, I had mixed emotions (to say the least, hah!). Half my brain rejoiced. “Yes! It’s working! I’ll get my period back soon!” I would think as I noticed parts of my body looking more like the body I’d had in college. But after months of no period… no signs… no nothing except a bunch of clothes that weren’t fitting right and a mind full of stress obsessing about the fact that I still couldn’t run, I broke down. I bargained with myself and added more exercise back into my life. Why should I live in torment, I thought, because of my self-imposed rule that I couldn’t exercise? If I only ran a few days a week, my body wouldn’t necessarily be *stressed out* (spoiler alert: this isn’t how it works). My bones seemed fine. Sure, I had some minor injuries in the past but nothing that led to any fractures. Sure, I didn’t have any sex drive but I didn’t feel sexy in my new, bigger body anyway. Sure, I was cold all of the time, but was that really a big deal? I googled and researched and tried to convince myself that I could, in fact, heal my body and continue to exercise. I wanted so badly to believe that I could remain a fit chick, a small runner girl, and recover from this.

Stage 4: Depression (woe is me)

I was fooling myself thinking that I could continue to exercise and ever get my period back. I felt ugly and sad as my body changed. I found myself spending hours scrolling through photos of myself from just a few years earlier and spiraling back into toxic thoughts. I analyzed how my face had become rounder and how skin folded over my old sports bras. I no longer fit in any of my shorts or jeans. I tried to practice what I preached and find aspects of my body that I appreciated (reading the work of my colleagues Robyn, Kylie, Heather, Rachel really helped), but I’ll be honest that it was super super hard. Learning how to honor my body outside obsessing over its changing appearance took a lot of sadness and I’m very glad to be moving on from this stage.

Stage 5: Acceptance (Imma be OK)

Not yet physically recovered, but no longer angry, bargaining or sad. My mind is healed, I mentally understand what’s happening and I’m confident my body will soon follow suit. I’m finally sitting still. I haven’t run in a month and ya know what, that’s OKAY! I’m actually feeling flutters of gratefulness for having gone through this difficult year of discovery learning how to be patient. Trust (more specifically, a lack of trust) was at the root of my eating disorder when I was younger and to heal myself from HA I had to really confront my fear and lack of trust in my own body.

I’ve started calling it for what it is. I wasn’t “overtrained” and I’m not “overly stressed.” I have hypothalamic amenorrhea. I am dealing with this health issue and I am healing my body. The shame game can step aside. I needed to gain weight and accept more fat tissue on my body. It’s cool. I wear a larger size now and my face is fuller — yeah I have a lot more bad body image days but this is temporary. I’m not not a runner, I’m just in a (really long) season of taking time off. I’ll be back, once my body knows that it can trust me again. I’m not going to be restricting calories or underfueling. I’m gaining weight but not weighing myself anymore. (That number doesn’t mean much and is destined to change throughout my life anyway.) Instead of eating out of sadness and obligation to stifle my body, I’m eating to honor it which in this case is eating more than I “burn.” A calorie surplus is what I need at this stage of life, plain and simple. Weight gain is not always a bad thing.

Though I haven’t completely closed the loop of recovery and I still haven’t woken up with the period that you know is going to come back with a welcome party (I have champagne waiting), I am 10000x more OK with where I’m at. I’m not perfect. I know how f*cking hard it can be to get real with your body and your mind. I’ve learned that I’m not one of those girls whose body heals after one month of recovery (maybe you are). It has taken 1+ year for me to fully accept that my body needed a serious change — and that that’s immensely terrifying but all a part of the process. It’s an amazing gift to have the perspective to be able to help other women who have gone through a similar struggle because of how normalized it is to live in an extreme energy deficit. Sometimes it pays to get angry, try your best bargain and get served up some real life lessons. But I don’t want you to feel as lost as I did.

If you are a female athlete or a girl who is also living with hypothalamic amenorrhea, know that you are not stupid or broken. Consider your missing period the best and most obvious sign that you get to make your body better and become the woman you’re meant to be. Find a registered dietitian who specializes in these issues, or post to the Lane 9 Facebook group for support and local resources! I’d love to talk with you about how you got here and how you can help yourself heal.