Understanding Labs with HA

Apr 16, 2024 | Uncategorized

Understanding Labs with HA

Have you been told your labs are normal but still missing your period? In this solo episode I’m going to walk you through what typical labs look like with Hypothalamic Amenorrhea. 

In this Episode:

  • Why labs can be “normal” but you’re still missing your period
  • Best labs to have to done to distinguish between HA and PCOS
  • When to test Progesterone to confirm ovulation 
  • What does low AMH mean with HA?
  • Is it possible to improve low AMH? 
  • Pros/cons of using labs to assess your progress in recovery 

Connect with Lindsey Lusson: 

Instagram: @‌food.freedom.fertility
Website: www.foodfreedomandfertility.com/
Twitter: @LindseyLusson
Tiktok: @food.freedom.fertility


Lindsey Lusson  00:00

And also remember that labs are a snapshot of what’s going on in your body at one point in time. So if labs are looking iffy and not totally clear on whether you’re leaning towards HA or PCOS, definitely have repeat lab work done. And I also want to discuss the idea that you can have very normal looking labs but still have HA. I think it is a common misconception to think that when you have HA, your estrogen is going to be super low FSH and LH. Very low… Again, we talked about how three fourths of women with HA have LH less than two. That doesn’t mean everyone does.

Lindsey Lusson  00:41

Welcome to the Period Recovery and Fertility Podcast. Here we discuss the challenging, rewarding and life changing process of recovering your period and finding freedom with food and exercise. Whether you’re hoping to regain your cycle to get your health back on track, or you’re ready to become a momma, this podcast is for you. While the recovery process isn’t always rainbows and butterflies, it’s my hope to bring you both information and inspiration during your own recovery journey. I’m your host, registered dietitian and fellow HA, woman Lindsey Lusson. 

Lindsey Lusson  01:12

Hey ladies, welcome back to another episode of the Period Recovery and Fertility Podcast. Today we are going to do a deep dive into typical and atypical labs with hypothalamic amenorrhea. Labs are such an important part of getting the proper diagnosis with hypothalamic amenorrhea. However, labs can also serve as a pretty big gray area. Because if you’re listening to this, you might be saying, hey, all my labs came back normal, but my period is still missing. 

Lindsey Lusson  01:40

What’s up? So we’re gonna talk about that a little bit today. We’re also going to talk about what are the typical lab values that we would expect to see for somebody who’s experiencing period loss due to hypothalamic amenorrhea. And we’re going to talk about kind of some abnormalities that we might see, things that I’ve seen more in practice than an actual research. And kind of what these abnormalities are that might be going on with you as you’re either trying to get the right diagnosis with HA. Or things that can go on during the recovery process that can make labs super confusing.

Lindsey Lusson  02:09

So we will touch a little bit more on distinguishing between HA and PCOS. But if you’re looking for more information on the differences between HA and PCOS with regards to physical symptoms, and labs. I highly recommend going back and listening to Episode 48 and Episode 12 on our podcast where I interviewed two different PCOS dieticians. Two people who actually work with people with PCOS that can provide more information on either getting that condition diagnosed or potentially ruling it out. 

Lindsey Lusson  02:42

We will talk about a little bit of the overlap and confusion and what is typical with PCOS versus what is typical with HA today as we’re discussing labs. Then I also want to get into other hormones. Kind of what we’re looking for when we’re testing what these hormones do for our bodies and what they mean for our fertility. I’ve also pulled in some of your questions that you guys submitted through the Google form over Instagram about labs. 

Lindsey Lusson  03:08

So today’s episode will hopefully be pretty comprehensive in understanding what you should be looking for in terms of where your lab values should be when you have HA. What they can look like in recovery. And maybe even as a starting point, what labs to request when you are going to your annual OBGYN visit. Or working with a reproductive endocrinologist and you want to kind of take a closer look at what’s going on with your body.

Lindsey Lusson  03:33

So when I’m working with clients that have hypothalamic amenorrhea, and they say, “Hey Lindsay, what lab should I be having tested?” How can we look at these, what are these mean? What I encourage my clients to have tested is their estrogen, progesterone, their FSH. their luteinizing hormone or LH. Then also if we are trying to rule out PCOS or we have concern that PCOS is going on in addition to HA, I recommend that they look at a free testosterone. 

Lindsey Lusson  04:02

Total testosterone can be helpful as well. But I’ll talk a little bit about kind of the differences between the two. Having those hormones tested as a starting point can give you and your provider a lot of information about what’s going on with your hormones and why your period is missing. So I’m gonna kind of go through all of those and talk about what they are, what they do, and what are the typical expected values with HA. 

Lindsey Lusson  04:26

So we’ll start with estrogen. Estrogen is a sex hormone that is essential for our reproductive health. In addition to our reproductive health and our fertility, it also plays a role in circulation, blood flow, bone metabolism, collagen production. And also in memory and cognitive function. If you go back and listen to episode 39, what happens if I don’t get my period back?, I do go way more in depth about estrogen and its role in our body. In particular with bone metabolism and cognitive function and cardiovascular health in kind of explaining, hey, like what’s going on with the body? And why is it not good to remain in a low estrogen state. 

Lindsey Lusson  05:05

So definitely give that one a listen if you haven’t listened to that already. But estrogen is also one of our major players in the female reproductive cycle. It’s primarily made during the ovaries during reproductive years. But it’s also made in the adrenal glands and fat tissues. Those are two other areas where estrogen is secreted. And little fun fact, there’s actually three different types of estrogen. So Estrone or E1 is the primary form of estrogen that your body makes after menopause. 

Lindsey Lusson  05:34

Sometimes we see women with HA have misdiagnosis of early menopause. So fun fact, remember that the average age for menopause is 52. And if that’s what your doctor is saying, hey, it looks like your ovaries are asleep, that’s something I’ve heard before. Or your estrogen is so low, this must be like menopausal. Know that during HA, your labs can kind of mimic that early menopause. And it’s important to have further testing done and to not just settle on that diagnosis. Especially if you’re getting that diagnosis in your 20s or your 30s.

Lindsey Lusson  06:05

And beyond E1, we have our estradiol, E2, which is our most potent form of estrogen. This is going to be your primary form of estrogen during your reproductive years. So it’s actually E2 that we’re testing for on blood tests. When you go and have your hormone panel done, that is the one that we’re actually testing for. Then finally, there’s estriol or E3, and that is the primary form of estrogen that the body produces during pregnancy. 

Lindsey Lusson  06:29

Typical lab values for estrogen whenever you are missing your period due to HA are probably going to be in between as low as 5. I’ve seen that with some clients. And you can even have them more kind of in the normal range. But what’s typical is estrogen somewhere in the 30s. A lot of people who are struggling with period loss and have been missing their period for years won’t have an estrogen much higher than 30. And that’s kind of a typical value that I see. Again, I’ve seen it very low. Then I’ve also seen it more in the normal range. So I’ve had clients that have had estrogen around 50,60, even 70s. And that can even fall in the normal range, which I’ll talk about here in a second. 

Lindsey Lusson  07:09

But more often than not, we are seeing estrogen levels that are low when someone has hypothalamic amenorrhea. In fact, most hormones are kind of on that load and normal side with hypothalamic amenorrhea. Our FSH and LH are two that can be very low, or they can kind of fall more in the low normal category. So let’s talk a little bit about FSH first and then we’ll get into LH. 

Lindsey Lusson  07:33

So FSH stands for follicular stimulating hormone, which is a hormone that’s released by the pituitary gland and acts on the ovaries. FSH is named really really well. Its main function is to stimulate the growth and maturation of follicles which are tiny, fluid filled sacs that are located inside the ovaries. So during our menstrual cycle when there is proper communication between the brain and the ovaries, FSH is released by the anterior pituitary. And acts on the ovaries to start growing and developing follicles. 

Lindsey Lusson  07:34

Follicles are also called cyst. So if you were to get an ultrasound done, and you have cysts on your ovaries, that is not necessarily a bad thing. I know sometimes we think oh my gosh, cysts that means disease or that means polycystic ovarian syndrome. Not always and we’ll talk a little bit more about that too later when we start talking about AMH. That having cysts on your ovaries, while it is part of the diagnostic criteria for PCOS, a lot of women with HA are also going to present with cysts on the ovaries. 

Lindsey Lusson  08:33

And with HA, there’s improper signaling from the brain. Which is why these follicles aka cysts don’t grow to an appropriate size and because of that estrogen levels remain low. So as FSH is stimulating the follicles to grow in a typical cycle as the body is preparing for ovulation. The follicles as they increase in size, they begin to release estrogen. Once estrogen has reached a peak that is what triggers the beginning of ovulation. So with HA, FSH levels are low. And because they remain low, we typically see estrogen continue to stay low and somebody continues to not ovulate and not have a cycle. 

Lindsey Lusson  09:12

Another hormone that’s typically low with HA is luteinizing hormone. And luteinizing hormone is another hormone that’s released by the pituitary gland. It’s responsible for triggering the release of an egg from a mature follicle for ovulation. Luteinizing hormone is actually what you’re testing for when you’re taking an ovulation predictor kit or an OPK test. It’s that surge in LH that actually triggers the release of the egg from the follicle and that is the beginning of ovulation. 

Lindsey Lusson  09:41

So when you’re taking OPKs and your body has HA, it’s very unlikely that you’re getting a positive LH. Because your body’s probably not around the time, it’s probably not ovulating. We’ll talk a little bit more about why you might see higher LH with HA. That’s kind of a subtype or in atypical lab value that I’ve seen with some client’s. But more often than not on a blood test, LH is going to be low. When you’re taking an OPK, you may or may not be getting kind of a line indicating that LH is present in the urine. 

Lindsey Lusson  10:11

But you’re probably not going to be seeing a positive LH or a positive OPK test. More often than not LH levels are pretty low. And kind of the lower it is the more severe if you will your version of HA is. It’s been estimated that more than 75% of women have LH values that are less than two with HA. Other than normal reference range can be anywhere between 2 and 15 in the follicular phase right before ovulation.

Lindsey Lusson  10:38

So as a recap, with HA, we’re typically seeing estrogen levels that are low, sometimes low normal. Then we see FSH and LH levels that are typically more in that low normal range. More often than not, we’re seeing LH values that are very low. Perhaps below two international units per liter.

Lindsey Lusson  10:57

The next relevant hormone that I want to talk about is progesterone. And progesterone is our pro gestation hormone, meaning that it is preparing our body for gestation or pregnancy. So another one that’s appropriately named. Progesterone’s main job is to prepare the endometrium. Which are the lining of your uterus for a fertilized egg to implant and grow and become a pregnancy. If pregnancy does not occur, the endometrium is then shed and that’s your period. So this is why we talk about when someone ovulates only one of two things can happen after ovulation. You are either pregnant, or you get your period. 

Lindsey Lusson  11:32

The reason why I like to have my clients have their progesterone levels tested when were working together. And we’re seeing where somebody is progressing through recovery is because we’re only going to see that marked increase in progesterone after ovulation. So if you were to have your progesterone levels tested, and that value is greater than three nanograms/milliliter than you did ovulate. 

Lindsey Lusson  11:55

So sometimes I’ll be working with clients, and especially if they were to have baseline labs that were done. And then let’s say they retest their labs six to eight weeks after working with me. Then we see a progesterone level above that amount. We know Hey, cool, your body has ovulated you are either about to get your period. Or you are about to be pregnant. 

Lindsey Lusson  12:13

So having your progesterone tested is still helpful, even though typically we see progesterone levels that are very low. However, if someone were going in for cycle day three labs, which is what most doctors will tell you to do. When you do have a cycle is hey, come in on cycle day three. That’s when we want to test all of your hormones. That’s kind of where most of the reference ranges are built around. Is that cycle day three? We would expect your progesterone levels to be low on cycle day three of your cycle anyways, because you haven’t ovulated. So sometimes labs won’t include that in their standard hormone panel. 

Lindsey Lusson  12:48

If you want to have your progesterone levels tested to either indicate whether or not you are ovulating or just for more information, you might have to request that. And if you are cycling regularly, or if you’re cycling semi regularly, let’s say your period comes every 60 to 90 days, and you want to know Hey, am I ovulating on the cycles even though they’re irregular. Be sure to have your progesterone tested seven days after you ovulate. Some labs will say come in for a cycle day 21 progesterone. And because most people don’t ovulate on cycle day 14, they might have falsely low progesterone levels. 

Lindsey Lusson  13:23

So just little tidbit if you’re listening and you have irregular cycles and you want to confirm ovulation, always go seven days after suspected ovulation to test peak progesterone levels. 

Lindsey Lusson  13:33

So we’ve talked through estrogen, progesterone and FSH and LH at this point. The other hormone that I recommend having tested at the beginning of your period recovery journey or especially if you are in the early stages of figuring out hey, do I have ha or PCOS is testosterone or free testosterone. This is again is really important to kind of look at to help rule out PCOS. So testosterone is our primary male sex hormone but it’s also made in females by the adrenals and the ovaries. It’s one of our main androgen hormones. And which can be elevated androgens can be the primary driver for PCOS. Which is why we want to look at that.

Lindsey Lusson  14:08

The pattern of elevated androgens isn’t observed in all women with PCOS. But the vast majority I think at this point, research is saying over 70% of women do have elevated androgens that are visible on a blood test. If you’re not having a blood test done, a lot of women with PCOS will have physical signs of elevated androgens. Such as excess facial hair or body hair, cystic acne, insulin resistance and those types of things. However, sometimes we can not have those symptoms and it can be very evident on a blood test. So always important to have lab work done as part of the diagnostic criteria for your missing period. 

Lindsey Lusson  14:45

And with your textbook versions of HA this is going to be very apparent. Most women with HA don’t have elevated testosterone. Their testosterone levels are typically more low or they might be kind of at low normal like we talked about with the FSH and LH and sometimes estrogen.

Lindsey Lusson  15:00

And testosterone is important because it plays a key role in our libido. Also in our bone health, muscle metabolism, mood, energy, and how we present as females. So a lot of times women with HA, even if they aren’t having their testosterone tested, they’ll notice some of those signs decrease libido, decline in bone mass. Not able to make a whole lot of gains in the gym because they’re not able to put on muscle. And so it is important that we’re thinking about testosterone when we’re thinking about getting our hormones balanced again.

Lindsey Lusson  15:29

A little bit more on testosterone with HA. I do think that it’s important to, if you suspect you have HA and then you come back and you have a testosterone level that slightly elevated slightly out of range, I might recommend having a free testosterone tested or to look at other markers for androgens like a free androgen index. That way, we can really make sure that this isn’t just a one off slightly out of range value. I do think that some women with HA, they’re working with a provider who leans a little bit more on diagnosing PCOS or was more familiar with PCOS. 

Lindsey Lusson  16:03

Some providers are kind of going to kind of be looking for it. And they might go back to the Rotterdam criteria and be like, “hey, you’ve got a missing or irregular period.” And “we have cysts on your ovaries and your testosterone is slightly out of range.” It’s definitely PCOS. So you definitely have to do a little bit of detective work here. 

Lindsey Lusson  16:22

And also remember that labs are a snapshot of what’s going on in your body at one point in time. So if labs are looking iffy and not totally clear on whether you’re leaning towards HA or PCOS, definitely have repeat lab work done. I also want to discuss the idea that you can have very normal looking labs but still have HA. I think it is a common misconception to think that when you have HA, your estrogen is going to be super low FSH and LH. Again, we talked about how three fourths of women with HA have LH less than two. That doesn’t mean everyone does

Lindsey Lusson  17:03

I have definitely worked with clients that have LH levels that are more in the normal range. And estrogen levels that are more in the normal range. But if we look at the diagnostic criteria for HA, what we are looking for is somebody who hasn’t had a period in longer than three months. We want to first rule out other causes of period loss. Such as pituitary tumor, such as PCOS, such as primary ovarian insufficiency. 

Lindsey Lusson  17:32

We want to rule those things out first. Then if she has a missing period, she has amenorrhea and her estrogen is less than 50 pica grams per milliliters, her FSH is less than 10 international units per liter, and her LH is less than 10 international units per liter.  Then she can have HA. So again, ruling out those other organic causes for period loss and then looking at those labs. That can be diagnostic criteria for HA. 

Lindsey Lusson  18:02

However, if you were to look side by side at the levels for estradiol, FSH and LH and to look at the typical HA ranges. Again less than 50, less than 10, less than 10 for estradiol, FSH and LH respectively and then you were to look at the normal reference range, there is a decent amount of overlap. And you might already be experiencing this. You go and you have your labs tested and your estrogens like 35, your FSH is three and your Lh is also three.

Those are normal lab ranges for somebody on cycle day three. And so what I often observe is that somebody will go have their labs done. Then they will get a call back from their doctor’s nurse saying your labs are normal. Come see us again in six months. Or we recommend starting fertility treatment because you now have unexplained infertility depending upon where you’re at in your period recovery journey, or what your goals are at that point in time. 

Lindsey Lusson  18:57

And so again, some of this responsibility comes back to you as the patient to say, hey, actually my estrogens 30, or my estrogen is 50 or my estrogen 75 even, but I haven’t had a period in nine months. So like I want further testing, right. I want a referral to a fertility specialist or something. Some of it is going to come back on you to do further investigations and ask the right questions.  Which is why I really want you guys to have this information about labs. And to be empowered when you are working with your providers. 

Lindsey Lusson  19:29

Now I did get a question about using labs as a marker for recovery. Like where should we expect our labs to be going as we’re working on recovery. We always want to see them be moving more towards the normal range. What is typical is for LH and FSH to normalize first and for estrogen to kind of lag behind. So when I’m working with clients on HA recovery we might have a baseline labs of estrogen at five. LH you know undetectable FSH around two.

Lindsey Lusson  20:00

And then after I’m working with someone, what we’ll typically see is FSH and LH rise to a more normal level. Maybe around six or eight. Then sometimes estrogen can just hang out and lag behind in like the 30s for a while. There are definitely strategies that we work on inside the Food Freedom Fertility Society to get you unstuck. And to really boost those estrogen levels so that we can get over the hump and get you ovulating again. So that you can get your cycle back. But that’s a pretty typical pattern is to again, first see FSH and LH, normalize, estrogen lag behind a little bit. That’s usually the one that’s kind of dragging behind. 

Lindsey Lusson  20:33

And estrogen levels can increase pretty dramatically if somebody’s following a targeted recovery plan in a matter of weeks. So if you’ve been working on recovery for a while now and your estrogen is still really low, you’re making targeted changes, and it’s still really low. You know, it’s a really good time to be reaching out and getting more support. Because we can definitely see things turn around rather quickly. We just have to figure out what are the missing pieces still in your recovery plan. 

Lindsey Lusson  20:56

Alright, so now that we’ve talked about kind of what’s typical when you’re missing your period with HA and what’s typical during the recovery process, after you’re working on getting your period back with HA. I want to talk about kind of some atypical things that we might come across when somebody is having their lab work done. And the first is seeing elevated LH. I’m talking about LH that might be two to three times the amount of FSH. And this becomes really concerning, because while it isn’t technically part of the Rotterdam diagnostic criteria for PCOS. 

Lindsey Lusson  21:26

When somebody has a luteinizing hormone, or LH level, that is two or three times the amount of FSH that can be indicative of PCOS. However, I have seen in a handful of clients during HA recovery, this idea of LH sort of overshooting during the recovery process were really really trying to ovulate. So the body sending out more and more and more and more signaling almost to the point where we appear to have this kind of false surge of LH. 

Lindsey Lusson  21:54

And if you were to happen to have lab work done around that time, you might capture again, lab work being a snapshot of what’s going on in your body at one point in time, you might happen to capture that through bloodwork. I have seen physicians with repeat bloodwork, see that latch onto that and say, Oh, you don’t have HA after all, you have PCOS. So just caution and understanding that repeat lab work might be necessary to really get a good picture of what’s going on with you. 

Lindsey Lusson  22:21

Now on the flip side, if you have elevated LH on a blood test, and you’re taking OPKs, which again, measure luteinizing hormone and your OPk’s are always positive. And so we have a chronically elevated LH, that might be PCOS. And that might, you know, warrant some further discussion and some further blood work and work up to look at some things. But a one singular increase in LH that happened to be captured by bloodwork does not mean that you have PCOS. So if this happens to you be aware that that can happen. And to also understand again of the snapshot idea when you’re having lab work done. 

Lindsey Lusson  22:56

I have also seen clients get lab work done and capture their LH surge. So sometimes LH is surging because your body is gearing up to ovulate in the next 48 hours. So sometimes that happens on bloodwork as well. Of course there is always the idea that you could have a dual diagnosis of HA and PCOS. What we typically see here is that initially somebody’s bloodwork looks more like HA and the HA is kind of masking the PCOS. Now, PCOS is a chronic condition. So if you have PCOS, you probably have it for life while you can symptom manage and, you know, make things better for yourself. Your PCOS isn’t necessarily going to go away. 

Lindsey Lusson  23:35

Whereas HA is a little bit more of an acute condition. I mean, granted people can have HA for years and years and years like myself for having it for over a decade. But HA is like correctable and reversible. And so if you were to be one of the few people who have a dual HA and PCOS diagnosis, you do have to deal with the HA first because if you don’t well, you’re just never going to have a period and you’re never going to ovulate and you’re not going to be able to make any strides unless you deal with the HA first. 

Lindsey Lusson  24:01

However, in some people as they recover from HA, there HA will no longer be masking the PCOS. And then there might also be PCOS symptoms that we have to start addressing through lifestyle management, etc, etc. However, I will say that that’s more rare than common. More often than not, I see people go into HA recovery thinking that they might have a dual diagnosis and thinking oh, well, I don’t want to make my PCOS worse. And then sometimes that just kind of keeps them stuck and never really dealing with HA. 

Lindsey Lusson  24:29

So best advice, deal with the HA first. If and when PCOS becomes an issue for you, you can kind of deal with that later on. 

Lindsey Lusson  24:37

All right, I want to end by talking about AMH values with HA. This seems to be a common conversation that comes up. In fact, I got a couple of questions around AMH from you guys that submitted your questions for this episode. And I want to lead with explaining first what AMH is because I think there’s a lot of confusion on what it is what it means. In particular with what it means for your fertility. And then also talk about what is typical and why we might see values that are out of range with AMH in somebody who doesn’t have a period of due to hypothalamic amenorrhea. 

Lindsey Lusson  25:11

So AMH is a test that measures the levels of anti mullerian hormone. That’s where the AMH comes from, which is an estimate of how many eggs that you have left inside your ovarian vault, if you will, how many eggs that you have left compared to your age matched peers. AMH naturally declines with age. So the range of what’s normal will depend upon how old you are. 

Lindsey Lusson  25:33

AMH gets a lot of attention because it can predict how well somebody will respond to an IVF cycle. So if you’re working with a reproductive endocrinologist, of course, they’re going to test your AMH . If your AMH just sky high, then they’re like, let’s run some IVF cycles, you’ve got a really high chance of getting pregnant. And if you’re AMH is really low, they’re probably going to say we need to start IVF tomorrow. We might need to do multiple cycles and this is not good. 

Lindsey Lusson  26:01

A lot of our data for AMH and why it gets so much attention is because of IVF cycles. It is a predictor for how well your body is going to respond. However, outside the context of IVF,  AMH is actually a pretty flawed representation of fertility especially when you aren’t ovulating regularly. With HA clients, I’ve seen both high and low values for AMH. So kind of understanding a little bit more about what AMH is and how it’s made. The cells inside the follicles in your ovaries produce AMH. 

Lindsey Lusson  26:34

So if your body is in HA and a more severe form of HA and it’s not growing any follicles, your AMH will appear falsely low. On the flip side, if your body is making follicles, perhaps multiple follicles but they’re not quite getting to that point of being a dominant follicle primed and ready to ovulate and then they’re kind of just stuck there hanging out. You might have multiple follicles and therefore a falsely high AMH. 

Lindsey Lusson  27:03

We see this a lot with PCOS. But because some women with HA can present with polycystic ovaries, again multiple follicles on their ovaries that aren’t quite there and aren’t ready to ovulate. But you’re kind of just stuck very similar to what’s going on with PCOS. Sometimes we can see that falsely high  AMH and I’ve even seen clients have falsely high AMH with HA going on and provider saying Nope, you have PCOS because your ama is off the chart. So again, thinking context about reference ranges for AMH  depending upon your age. An AMH of five can be high, you know work with your provider in the reference range will vary depending upon your age. 

Lindsey Lusson  27:45

But when we see AMH levels, kind of like off the charts high 15,20,  I think that’s really more where we start to see the concern for PCOS. However, I think we really have to be careful. And again, circling back to this whole idea of lab work or being a snapshot of what’s going on at your body at one point in time. And unlike I feel how we’re often told about AMH, AMH isn’t this stagnant thing and it can change over time. I feel like so often we’re being told high AMH is scary for fertility. Low AMH is scary for fertility. And that’s true. Again, if you were to start a IVF cycle, if you came back and you had an AMH of point five, and you were planning to start IVF this month, yes, that would be concerning. 

Lindsey Lusson  28:29

However, there are lots of strategies that you can take for improving your AMH. Increasing it if it’s low. Lowering it if it’s high. Step one to correcting and getting your AMH in that normal range is to have regular ovulatory cycle. And if you have low/high AMH, with hypothalamic amenorrhea, I would not completely ignore that value. But I would first focus on getting your body ovulating, get your cycles normalized, and then retest it and see where it is. So kind of just push pause on putting so much stock into that value, especially if you’re pursuing or considering pursuing natural fertility, AMH  is definitely something that can be improved. And there’s lots of strategies that we can do with lifestyle and supplements to get it back in a healthier range. 

Lindsey Lusson  29:16

All right, so that ends it for our deep dive into labs and typical labs with HA. I hope that this threw me a bit of nuggets of information even if you are familiar with what typical labs look like with HA, or at the very least armed you with some information on tests to request when you’re working with your provider to help lead you to the right diagnosis and empower you and knowing that your body is capable of getting your period back, ovulating regularly and being able to be fertile and becoming a mom. 


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I’m a fertility nutritionist and registered dietitian who specializes in hypothalamic amenorrhea. My passion is helping women trying to conceive find freedom with food and exercise, so they can recover their period, and get pregnant naturally.

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Jan 19, 2022

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Can I get my period back without gaining weight?

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 -...

Why Breakfast Matters for Fertility

Why Breakfast Matters for Fertility

Do you often find yourself skipping breakfast, with the desire to "save up" for later in the day? This habit might be more impactful on your fertility than you realize- especially if you're on a journey to heal from hypothalamic amenorrhea. As a registered dietitian...

Root Causes of Period Loss & Infertility

Root Causes of Period Loss & Infertility

Dr. Kelsey is a licensed Naturopathic Physician from Portland, OR who specializes in fertility + menstrual health. Balancing roles as a devoted mother of 2 and a thriving practitioner, she weaves comprehensive medical expertise with a holistic approach that nurtures...

Overcoming denial & making changes to support fertility

Overcoming denial & making changes to support fertility

Beth is a registered nurse and nursing professor with a background in obstetrical nursing from just outside St. Louis, Missouri. In an effort to "get in the best shape possible" before she and her husband tried to conceive, she unintentionally set herself down a path...

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