Is Exercise Always the Problem in Hypothalamic Amenorrhea? A More Precise Way to Think About Load

Many women with hypothalamic amenorrhea love their walks, runs, Pilates classes, weight training sessions, and HIIT workouts. Unsurprisingly, the suggestion to cut back on exercise is often met with about as much enthusiasm as a surprise tax audit.

So, is exercise always the problem?

Not necessarily.

The more accurate question is whether the body has enough resources to support everything being asked of it.

After all, the human body was designed to move. Movement is generally beneficial. The issue is not movement itself. The issue is the total load placed on the body and whether that load exceeds what can be recovered from.

One of the most common objections we hear is: "But my friend does the exact same workouts and still gets her period."

Maybe she does.

But she is not living your life.

Exercise is only one form of stress in HA recovery.

The body also has to account for work demands, relationship stress, perfectionism, inadequate sleep, underfueling, dieting history, travel, illness, caregiving responsibilities, and the mental effort required to hold everything together while pretending you are not stressed.

The body does not separate these categories into neat little buckets. It simply experiences load.

This is where many women get stuck. They count their workouts but fail to account for everything else they are carrying. A new promotion. Longer work hours. Cutting carbohydrates. Training for a race. Planning a wedding. Launching a business. Starting graduate school.

Individually, none of these may seem significant enough to disrupt the menstrual cycle. Collectively, they can become the straw that broke the hypothalamus's back.

As fertility awareness educator Lisa Hendrickson Jack frequently emphasizes, the menstrual cycle is not just about reproduction. It is a valuable indicator of overall health and physiological function. When cycles disappear, the body is communicating something important.

Dr. Paula Hillard, Professor of Obstetrics and Gynecology at Stanford University, puts it this way:

"The menstrual cycle is a window into the general health and well being of women, and not just a reproductive event."

For women with hypothalamic amenorrhea, that window often reveals a mismatch between the demands being placed on the body and the resources available to support them.

The goal is not to convince clients that exercise is bad. The goal is to help them understand the value of recovery.

Sometimes that means reducing exercise. Sometimes it means eating significantly more. Sometimes it means improving sleep. Sometimes it means addressing the constant pressure to perform at one hundred percent in every area of life.

And sometimes it means all of the above.

A Note for Coaches

Exercise does not always need to be eliminated.

For some clients, strategic reductions in training combined with increased nutrition are enough. For others, exercise may be the only flexible variable available.

This is where coaching becomes highly individualized.

Timelines matter as well. If a client hopes to conceive in the near future, the conversation shifts from what is theoretically possible to what will most efficiently support recovery. If she is unwilling or unable to modify exercise, what other sources of load can be adjusted? Can food intake increase? Can additional rest be prioritized? Can work demands be reduced, even temporarily?

The most effective coaches are not attached to a single recovery formula.

They understand that every client arrives with a unique load profile. Their job is to identify where flexibility exists and help the client create enough space for her body to once again view reproduction as a safe investment.

Works Cited:

Hendrickson Jack, L. (2019). The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility. Fertility Friday Publishing Inc. 

Hillard, P. J. A. (2014). Menstruation in Adolescents: What Do We Know? and What Do We Do with the Information? Journal of Pediatric and Adolescent Gynecology, 27(6), 309 to 319.