When Stress Becomes Too Much: The Role of Mental Stress in Hypothalamic Amenorrhea
Stress is something that perfectionists know and love.
And I say that with a lot of compassion, because I know many women recovering from hypothalamic amenorrhea fall into that category. Perfectionists often thrive on stress. In many ways, we rely on it to keep going. It can make us feel productive and disciplined, and like we are staying on top of everything and succeeding in what we want to do with our lives. We try to juggle so much just to feel accomplished.
There can almost be a sense that if we slow down, things will fall apart.
For many women who lose their periods, the control and rigidity around food and exercise often start as a way of coping with that stress. I’ve seen it in so many stories, and honestly, I saw it in myself, too.
Think about it. When we exercise, our bodies release endorphins and other chemicals that make us feel good. It can almost feel like an “anti-stress drug.” And I want to be clear — there is nothing wrong with enjoying that post-run rush or feeling good after movement. Movement can be a beautiful way to care for and nourish our bodies.
But like most things, there is a point where it can go too far.
One of the most helpful things my therapist shared with me when I was healing my relationship with exercise was the image of a pendulum. When we don’t move enough, we know that can be harmful to our health. But there is also the other side of the pendulum — the place where we have pushed our bodies too far, overtrained, and burned ourselves out.
And the tricky part is that when we’re in that place, it can still feel like we’re doing something “healthy.”
It can feel like this is what we have to do to stay disciplined, to stay healthy, or to stay in control.
But sometimes the very thing we think is helping us is actually creating more stress for our bodies.
When Exercise Becomes Our Only Coping Tool
One of the things my therapist said to me while I was starting recovery that really stuck was this: if we only have one tool in our toolbox to cope with stress, we miss out on all the other ways we could learn to care for ourselves.
Exercise and eating nourishing foods can absolutely be good for us. But so can cuddling with our partner, laughing with friends, playing with younger siblings or nieces and nephews, or spending time in prayer or worship with others in our faith community.
These things nourish us too.
When exercise becomes the only way we know how to deal with stress, it creates a fragile system. Because what happens when you can’t do it?
What happens if you are injured?
What happens when your body is exhausted?
Or what happens when you are healing from hypothalamic amenorrhea and your body is asking for something different?
If that one coping skill disappears, many women feel like everything else falls apart.
But the truth is that you were made for more than one way to handle stress.
You deserve to have a full toolbox.
The Stress That Got Us Here
Another difficult reality is that the stress we were trying to cope with is often part of what got us here in the first place.
Hypothalamic amenorrhea (HA) occurs when the brain temporarily suppresses reproductive hormones. Specifically, the hypothalamus reduces the pulsatile release of gonadotropin-releasing hormone (GnRH), which disrupts ovulation and causes periods to stop (Mariam et al. 2023).
Research shows that HA is commonly triggered by a combination of factors, including:
psychosocial stress
restrictive eating or energy deficiency
excessive exercise
Often, it is not just one of these things, but a mix of several that slowly pushes the body into a state of survival mode (Mariam et al. 2023).
Mental stress plays a major role in this process.
When we experience chronic stress, the body activates the hypothalamic-pituitary-adrenal (HPA) axis, increasing stress hormones like cortisol. Elevated cortisol can interfere with the hypothalamic-pituitary-ovarian (HPO) axis (the system responsible for ovulation and menstrual cycles) (Mariam et al. 2023).
Stress hormones can even directly suppress the neurons that stimulate GnRH release in the brain, reducing the signals that normally drive ovulation (Mariam et al. 2023).
In other words, when the body feels like it is under constant pressure or threat, reproduction becomes a lower priority.
From a biological perspective, this actually makes sense. Historically, times of intense stress were not ideal environments for pregnancy. The body is trying to protect us.
But in modern life, chronic stress can come from so many places — work pressure, perfectionism, relationship struggles, or constantly feeling like we need to do more and be more.
The Psychological Side of HA
Research also shows that psychological stress plays a significant role in hypothalamic amenorrhea.
A systematic review examining psychological factors in FHA found that many women with the condition report stressful life experiences before the onset of HA. These can include family conflict, major life transitions, chronic stress, or other emotionally difficult experiences (Bonazza et al, 2023).
These stressors can contribute not only to the development of HA but also to its persistence if they are not addressed.
Because of this, recovery often requires more than simply changing nutrition or exercise patterns. Addressing mental and emotional stress can be an important part of restoring hormonal balance.
Some research even shows that cognitive behavioral therapy (CBT) designed to improve coping mechanisms and reduce stress, has helped restore ovulatory function in women with FHA (Mariam et al. 2023).
Learning New Ways to Cope
This was honestly a turning point for me in my own recovery.
I realized that if I wanted to heal, I couldn’t just remove exercise as my main coping strategy — I had to replace it with other ways of handling stress.
And that didn’t happen automatically.
It took time to build those skills.
It took time to learn how to sit with discomfort instead of immediately trying to outrun it. It took time to learn how to rest without guilt.
But over time, I started to realize that there were so many other ways to nourish my mind and body.
Spending time with people I love.
Being outside in nature.
Writing and reflecting.
Praying.
Allowing myself to slow down.
None of these things felt as powerful as exercise at first. But slowly, they became part of a much bigger foundation for handling stress.
And that foundation made healing possible.
You Deserve Recovery
If you developed hypothalamic amenorrhea while trying to take care of yourself, I want to acknowledge that.
Many women fall into HA because they are trying to do something good for their health. They were trying to reduce stress, feel better, or take control of their well-being.
Those intentions matter.
But I also want you to know that you do not have to stay stuck in patterns that make you feel trapped.
Recovery may require doing things differently for a season — especially when it comes to rest, nourishment, and your relationship with exercise.
But it can also open the door to a more holistic way of caring for yourself.
One where you are not controlled by what you think you “have to do” to be healthy.
One where your body, mind, and spirit are all supported.
It might not feel easy at first.
But you still deserve recovery.
Ready to Support Your Cycle and Fertility?
If you are struggling with hypothalamic amenorrhea or missing periods and want support restoring ovulation and fertility, you do not have to navigate it alone.
At Nourishing Minds Nutrition, we specialize in helping women recover their cycles and support fertility through evidence-based nutrition, nervous system support, and root-cause healing.
You can learn more about our Premier Period Recovery for Fertility program below.
Apply here to start your recovery journey.
by Bree VanCamp, intern at Nourished Fertility
References
Saadedine, M., Kapoor, E., Shufelt, C., Functional Hypothalamic Amenorrhea: Recognition and Management of a Challenging Diagnosis. Mayo Clinic Proceedings, Volume 98, Issue 9, 1376 - 1385
https://www.mayoclinicproceedings.org/article/S0025-6196(23)00282-3/fulltext
Bonazza, F., Politi, G., Leone, D., Vegni, E., & Borghi, L. Psychological factors in functional hypothalamic amenorrhea: A systematic review and meta-analysis. Frontiers. https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.981491/full