Bulimia, Hypothalamic Ammenhorea & Lean PCOS Insights

I got my results from some important health tests last night and I’ve been sitting with my feelings since. I knew what I was expecting to come from these tests, which has definitely made it easier to sit with, however I would be lying if I said I’m not a bit overwhelmed. I also feel a bit of overwhelming calmness simultaneously because I feel like these results are the reassurance I’ve needed that I’ve got more going on than meets the eye and I am fully  committed to following through with what I need to, to heal my body and make it feel safe again. If you’re wondering what the heck I’m talking about I’ll explain, here, and a lot more in future blogs as well as my podcast that I will be launching soon (AH, YAY)! If you don’t want to read on you don’t need to, I’ll be talking about all of this as well, I just enjoy writing too because it is a form of expression and release for me. 

If you’ve been following my journey, or have connected with me, you may know about my eating disordered history and how open I am about it because it has helped me tremendously with healing. To be honest, I was a bit naïve then when I wrote about how much I struggled because I felt like I was passed the hardest part of my journey, but really my recovery was just beginning then. When  I wrote that blog post 2.5 years ago I was in a much better place with exercise and food, as I wasn’t abusing intense exercise every single day anymore and binge-eating/purging/abusing laxatives weekly anymore. To give you a short sum up, if you haven't tuned in, for over 5 years I had a very volatile relationship with food + training. I would often exercise 2+  hours a day, try to eat 1000 calories or less a day, binge-eat, use laxatives or purge, and continue these cycles.  They got worse when I was emotionally stressed as I used food to cope too. This isn't to say I didn't have some good times in my life during these years, but there was an underlying dysfunction there that ran my life.

I had about 3 single day random relapses after I posted my first honest recovery blog but pulled myself out of them and kept moving forward in self-love and forgiveness each time, they only lasted about a day. But the entire time after 2017 I was under-eating most days,, and still fearful of a lot of weight gain. I’ve felt safe in a smaller body for so long, and in the pursuit of “health” going 95% vegan & often raw-vegan did not support my body as an active human being. I am not saying vegans can’t be healthy, I’m saying it was hard for me to get the proper amount of calories as well as nutrients in my body to sustain my hormones. I was not stressing about food but I was under-nourished, partly unintentionally and partly probably due to my subconscious fight for control. I probably ate between 1100-1400 most days and this was not enough fuel to sustain my body, I likely need around 1800-2000 calories a day. During these times when I just got more into hot yoga too I felt better being in a smaller body, perhaps a bit influenced by the culture and social media portrayal of what advanced yogis look like. My practice is so much less about how I look now and so much more about how I feel, wow how things change in a short matter of time. When I was under-eating, and under-weight (FOR MY BODY, not on a standard chart), I was cold ALL THE TIME, exhausted even just walking up the stairs and waking up most mornings at 4:30 or 5:00 am feeling completely tired but wired at the same time. This was due to my body waking me up because of stressed out adrenals, and extreme hunger. I also got some cystic breakouts pretty often monthly but not nearly as bad as 5 years ago in the depth of my eating disorder. 

 So moving on, after losing my period for 5+ months, 3 times in a row over the last 3 years, and connecting with doctors, naturopaths and doing hours of my own extensive research I concluded that I likely have HA (Hypothalamic Ammenhorea) as well as a possible overlap with lean PCOS (Polycystic Ovarian Syndrome). Hormone imbalances associated with both of these conditions can arise from over-stress (emotional, physical, mental, etc), under-fuelling, over-exercising, environmental toxins and more. There are genetic components as well that come into play. If I do have both, I have to first recover from HA by making my body feel safe enough to start ovulating again, which will re-start my cycle, and then tap into balancing my hormones and improving possible PCOS symptoms that may arise (hormonal acne, etc). There is also a chance though that my androgen imbalances will be corrected with healing my HA because I have connected with other high-level athletes who have recovered from HA and they had similar endocrine (hormone) profiles as me. There is a lot more gaps in research and even more doctors/professionals in the health industry who are just simply not informed on the updated research so I’ve had to advocate for my health and fight for tests/referrals over the last couple of years which has been tiring. I’m finally making some progress and have my first Gyno. Referral within the next couple of months, although I really need an Endocrinologist referral which hasn’t been granted to me yet (hopefully soon).

So what is Hypothalamic Ammenhorea?

“Hypothalamic amenorrhea is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain and controls reproduction.” (https://www.shadygrovefertility.com/diagnosing-infertility/infertility-causes/female-infertility-causes/hypothalamic-amenorrhea)

HA is characterized my missing periods and in most cases low LH (Luteinizing hormone) on blood test, which is considered low when it is under 2 IU/L. This hormone surges right before ovulation but when a woman’s body doesn’t feel safe there is no surge and this hormone remains low. FSH (Follicle Stimulating Hormone) varies in women with HA, but in more severe cases it’s extremely low as well. Often seen in athletes of low BMI, but HA can occur in women of ANY size, with ANY training background. Actually there are women who have HA who don’t workout at all, but lose their periods because of emotional stress and usually a combination of under-fueling. It’s also much more likely for a woman to have HA if there has been significant weight loss in their history, including any range over 10 lbs. A true pioneer and leader in the field Nicola Rinaldi wrote a book called “No Period Now What” which has been AMAZING on my journey over the last two years. (http://www.noperiodnowwhat.com/) I would highly suggest visiting her website as well as her facebook group for women who have HA because it is a great support system, as well as provides numerous resources. Another important note is that since women with HA are not ovulating, they will likely have multiple follicles on their ovaries which just means that none are reaching ovulation, it does not mean that you can be diagnosed with PCOS. Many women are mis-diagnosed and there needs to be more data collected before proper diagnoses can be made. If you’re an active woman who has increased her exercise, began dieting or eating less (on purpose or not), lost 10+ lbs especially in a short period of time and are missing your period it is much more likely to be Hypothalamic Ammenhorea, not PCOS. HA recovery recommendations are: CUT ALL INTENSE EXERCISE (other than walking/gentle yoga), and eat minimum 2500 calories a day, no food restrictions and lots of rest. No adding in more intense exercise until 3 recovery cycles/months have passed. I am currently working with a health coach, my first appointment is in two days and she specializes in HA as well as PCOS, she also believes you don’t need to entirely cut exercise and I’m excited to have more professional guidance especially related to food and supplements, which I will post about. I have recently cut my intense exercise down in half. I am doing basically no cardio (unless I go up a hill on a bike for a second on my  joyful rides), especially no HIIT. I’m only doing hot yoga 1-2 times a week, lifting weights 1-2 times a week for an hour with many breaks, and sitting down more. I’m also eating any and everything that I feel like, which includes “off limit foods” or foods I’ve deemed “not healthy”.

When I first went to a doctor for help with cystic acne 5 years ago my blood work revealed I had almost non-existent LH and FSH (both below 1), low progesterone, (not sure what my estrogen was at this time because I wasn't well informed on hormonal health) and elevated androgens.  My doctor told me he thought I had Female Athlete Triad from over-training and under-fueling. I dismissed him because I was at my heaviest weight (130 pounds- 10 more pounds than I am now), and was still binging a lot during this time in my life. I did not believe someone in a normal sized body could have Female Athlete Triad. I never got the bone scan he sent me out to get, and I still haven't got one to this day, although I will need to soon. Hormonal imbalances associated with Female Athlete  Triad can lead to bone loss, Osteopenia and Osteoporosis, and at the age of 25 that is something that truly terrifies me.

There is a bit of a blurry line though which is where I am at in understanding my body and my healing right now. Those with PCOS  have elevated androgens on testing, often including: testosterone and DHEA-S, which are both elevated for me. As I started above I’ve connected with many healed athletes who had HA with these androgens elevated as well. They healed from rest and fueling, and their hormones returned to baseline. There is also quite an overlap between the two conditions because when the body is out of wack the metabolism of all the hormones can go in various directions. When stress is elevated, cortisol is released and then DHEA-S often elevates as well as a protective mechanism. Also equally important to symptoms if how we metabolize these hormones, because there is always a safer path-way. As I learn more with my health coach and naturopath, as well as my own healing experience, I will post more!!!

You might be wondering, what is PCOS?

Pcos: “Polycystic ovary syndrome (PCOS) is a condition that affects a woman's hormone levels. Women with PCOS produce higher-than-normal amounts of male hormones. This hormone imbalance causes them to skip menstrual periods and makes it harder for them to get pregnant.”

https://thepcosnutritionist.com/. She has many amazing resources and a number of free podcasts to listen to. There are many other great women with voices on this subject + personal experience, including: Dr. Fiona McCulloh from Toronto (https://drfionand.com/blog/).



After doing hours of my own research, and not receiving any formal diagnoses yet from doctors, I believe I have HA for sure, with POSSIBLE lean PCOS based on my lab results and current DUTCH test results. I just paid quite a lot for a detailed hormonal test to provide more insight into what’s going on in my body, through an interactive, full-body lens.Every women needs androgens, including testosterone, but in ideal amounts. Many high level athletes even at the Olympic level have elevated androgens but the research on this isn’t sure if that developed as a result of intense training lifestyles + genetics + etc or if these women would have had the same hormonal profiles had they not pursued intense sport training. PCOS is truly complicated and there are many different root causes of the imbalances, including but not limited to: insulin resistance, environmental toxins, high stress, allergies and more! Each woman is different and treatment is highly variable depending on your root cause, there is no one-size-fits-all approach and unfortunately many conventional doctors don’t know this either. PCOS is stereotypically seen in highly overweight women with insulin resistance, dark hair growth, acne and apple-shaped bodies. But there are MANY women who do not fit this stereotype who have PCOS too, some with insulin resistance who are lean/skinny and some who aren’t even insulin resistant. Also women with PCOS often have elevtated LH to FSH ratio, usually 2-3 times the level but this is not required for diagnosis. My LH was under 0.1 when this began, and my FSH was 1.0 which indicates a more extreme version of HA, although I still cycled at that time and it was likely annovulatory (I got a period but probably wasn’t ovulating). It’s important to work with a functional health coach or specialist in this area because there is a lot of knowledge with this condition alone that is CRUCIAL to know. I recommend Claire because I have followed her own healing journey from PCOS and her website is:

What is A DUTCH test? Dried Urine Test for Comprehensive Hormones* This is an amazing test administered by health specialists to get a really deep insight into sex and adrenal hormones and their metabolites. There is also insight into cortisol patterns, organic acids, 8-OHdG & melatonin. It’s a bit complicated to understand by yourself even with insight from the company so it’s really key to work with a specialist. Any person can benefit from this test especially if they feel like something is off in their body and traditional lab blood tests are coming back normal. I will go through my results in DETAIL on a future blog post to provide some insight into my learning as well as feedback from my health coach which will be coming in two days!! As an introduction though my main findings are that I have: low estrogen, low progesterone, high DHEA-S, high testosterone, normal free cortisol but low metabolized cortisol. The Cortisol results could also indicate a thyroid issue and although I’ve had many of my thyroid hormones tested I haven’t had my reverse T3 tested which would indicate if I have something deeper going on there which could be auto-immune OR could be a result of under-eating for many years and chronic energy deficit. Understanding your health really is a puzzle, our body is one giant complex puzzle trying to maintain homeostasis. I am simply writing my experience with trying to solve this puzzle to hopefully help other women out there who are researching desperately for answers. It took me SO long to find other women who had written about their experience with HA, but also having elevated androgens. There isn’t a lot of literature on that yet and I felt like I didn’t  belong in a category so I didn’t know what I needed to do to heal.  I’m still figuring it out one day at a time, but my research has definitely helped. I look forward to sharing more of my journey on this blog in the future as I continue to live and love myself.

I am NOT CERTIFIED and I am NOT a doctor. This blog is not intended to be substituted for any medical advice it is simply some insight into my journey of healing. I will continue writing about my journey, especially when I want to shrivel up and hide because I know I can help other people. Please don’t hesitate to connect with me, I love meeting new people and we can support each other.

PS. THE MORNING AFTER I WROTE THIS BLOG I GOT MY FIRST LADY FLOW IN 5 MONTHS, WHICH WAS COMPLETELY UNEXPECTED AND EXCITING. I’ve felt some breast tenderness for the last few weeks and my body felt like it was turning things back on, as I kept eating large amounts and resting more. This is just the beginning though of my recovery journey which I need to stay committed to… updates will follow.

MUCH LOVE,
ASH<3