If you’ve done any research on period recovery, you’ve most likely heard of “going all in,” or that gaining weight is a key part of healing your hormones. Many people hope that they are the exception – that they can regain their cycle without gaining weight – but biologically, there is a reason why this weight gain often plays such a critical role.
When you lose your period with Hypothalamic Amenorrhea (HA), your body has reached a point where it feels too stressed to handle all of its behind-the-scenes processes – digestion, breathing, the menstrual cycle, etc. It is forced to prioritize and, because reproduction (the menstrual cycle) is not necessary to survive, this is one of the processes that is shut down.
To get things going again, there are a couple things that need to be in place:
- A surplus of energy (for most, this means 2500+ calories), which will most likely lead to weight gain
- A drastic reduction in the intensity and duration of exercise
- Time and consistency
If any of these things are missing, you might be working to recover your period for a loooong time. Gaining weight alone likely won’t bring your period back if you’re continuing to engage in tons of exercise each week, you fail to address your disordered habits around food, or you’re living in constant fear of weight gain, which can hold you back from properly nourishing your body.
Want to Recover, but Scared to Gain Weight?
First things first, it’s important to acknowledge that weight gain can be scary. It’s the #1 fear that I see in my clients experiencing fertility issues related to HA, and while you might recognize that this fear isn’t really rational, it can still feel impossible to overcome. Everyone has some level of fatphobia because the message “fat is unhealthy/unattractive/unworthy” has likely been taught to you from a young age and reinforced over and over again through society, healthcare professionals, and various friends and family members. The $76 billion diet industry thrives off of this lie, and dismantling it takes time.
Many of my clients believe that their eating and exercise habits that led them to HA are healthy, but the reality is that period loss is a tell-tale sign that your body is undernourished. Although social media and pop culture often portray restrictive diets and intense exercise as healthy, I encourage my clients to challenge these messages. Renourishing your body for health and fertility requires some necessary fat gain to replenish nutrient stores, increase estrogen, and provide your body and your brain the right message about energy availability.
What about Reverse Dieting – Will that Work?
If you’re unfamiliar- reverse dieting is very slowly and strategically increasing your calories and macros to increase your metabolism while minimizing fat gain.
Sounds like a dream right? But does it work for period recovery?
I see a 3 few big problems with using a reverse diet to get your period back
- The very regimented and controlled nature of a reverse diet is actually not any different than macro/calorie counting for weight loss. What we have to remember when you lose your period with Hypothalamic Amenorrhea (HA) is that your body is already under a ton of stress. Continuing stressful and restrictive habits is NOT helpful for recovery. In fact, we have research that shows that the very nature of calorie/macro counting increases cortisol levels (1), which for us HA ladies is that last thing we need for want when our bodies are already over stressed.
- You need to gain fat in order to restore your fertility. If your goal is to gain weight but keep it controlled and minimize fat gain, you’re gonna have a hard time getting your period back and continuing to have regular ovulatory cycles. More fat = more estrogen which is the first hormone that needs to rise in order from proper signaling from the brain for follicular development and ovulation.
- It’s not actually addressing the real issue here. Let’s pretend you do a reverse diet and get your period back. Hooray! Now what? Are you going to be tempted to cut again in the future? Have you addressed your very permissional relationship with food? Are you still scared to eat carbs or gain weight?
I’ve worked with several clients who have gone the slow and steady, reverse diet approach. If this is you I don’t want to you think you’ve done it wrong or you’re a bad person for taking this route! Sometimes a reverse diet can be a helpful stepping stone in renourishing your body. But if you’ve reversed up to a decent amount of food and you’re still struggling with a missing or irregular period and/or you’re noticing you haven’t made the improvements you want with your relationship with food and your body, I would recommend changing your approach.
I’ve Accepted I Need to Gain Weight – But Will it Ever Stop?
When someone with HA commits to recovery, it’s impossible to predict the exact amount of weight that they need to gain to recover their cycle. This element of the unknown can be daunting, but the truth is you won’t gain weight forever because our bodies have a set point weight range they like to be in.
Set point weight is the weight at which your body naturally wants to settle. It’s influenced mostly by genetics, but also somewhat by hormones, metabolism, and other factors. When you restrict food and engage in disordered eating, your body may lower its set point weight to conserve energy. This is one reason why you’ve lost your period and may be struggling with infertility!
You will gain some necessary weight when you eat more to meet your body’s needs, but as your body finds that “sweet spot”, weight gain will level off and you’ll begin to maintain it as your body naturally settles into its set point weight. Some people also find (MUCH farther into recovery) that they naturally lose some of the weight they gained during recovery. If you’ve “overshoot” your set point weight range, rest assured your body will recalibrate in time. This is something that will happen naturally and does not need to be micromanaged or forced through intentional calorie restriction. Remember, engaging in similar behaviors that led to period loss initially is likely to have the same result- amenorrhea or cycle irregularities and hormone imbalance. Be patient with your body as it relearns how to trust a healthy amount of food for you.
A few important things to note about set point:
- Your set point now is likely not your same set point as a teenager or young adult
- Set point may be higher after prolonged restriction and period loss
- Set point weight is a range that may vary +/- 10 lbs.
But What If I’ve Already Gained Weight and Still Don’t Have a Period?!
Gaining weight can feel uncomfortable and frustrating, especially if your period still hasn’t returned. Before deciding that your body is “broken” or “unable to recover” like so many of my clients have thought before joining my program, there are a couple of reasons why weight gain alone may not bring your period back to consider:
Reason #1: You’re gaining muscle, not fat. In order to increase estrogen levels and support healthy hormones, your body needs an increase in body fat. If you’re eating more and continuing to exercise, especially weight or resistance training, it’s very likely that the increase you’re seeing on the scale is partially muscle gain.
Reason #2: Your metabolism has slowed to the point where you gain weight very easily without increasing your food intake that much. This is super common when there has been a long history of disordered eating. If your metabolism has adapted to say, 1300 calories, an increase to 1800 calories would likely result in weight gain, however, that calorie amount is still too low to support ovulation and getting your period back.
Reason #3: You’re still restricting carbs. Nutrition matters a lot when it comes to overcoming the energy deficit that’s led to period loss. While getting into a calorie surplus is important, things like macronutrient breakdown of your meals and snacks in addition to nutrient timing really matter. This is one area I see hold people back from recovery, especially when they’ve done almost everything right for recovery, but still no period.
Gaining weight is hard, but recovery is worth every pound- I promise. Finding that “sweet spot” where your body operates optimally is a wonderful place to be, but many women need clear guidance to get there.
If you’re just starting to tip your toe into period recovery or have been at it for months with no results, consider joining the Food Freedom Fertility Society, where you will have a community of women who have similar experiences to support you every step of the way. Rooting for you- and YOU GOT THIS!
You Can Recover from HA and Restore Your Fertility
Apply to Join the Food Freedom Fertility Society.
- Tomiyama AJ, Mann T, Vinas D, Hunger JM, Dejager J, Taylor SE. Low calorie dieting increases cortisol. Psychosom Med. 2010 May;72(4):357-64. doi: 10.1097/PSY.0b013e3181d9523c. Epub 2010 Apr 5. PMID: 20368473; PMCID: PMC2895000.