Incredible.
Awe-inspiring.
Genius.
These are just some of the words that come to mind when I think about the human body.
I remember when I first started studying physiology and being floored by the various organs and glands and what they were able to do.
Whether looking at the tiniest function of a cell or the body as a highly interconnected system, I was humbled by what it can do.
And this is definitely the case when I think about the hypothalamus. This tiny region in the brain has a huge impact on the body’s functioning, potentially more than any other organ or gland.
The hypothalamus has three main regions. Each one contains different nuclei, which are clusters of neurons that perform different vital functions.
The anterior region is mostly focused on the secretion of hormones. Hormones connected to:
The middle region is responsible for regulating and controlling appetite as well as growth, repair and development via growth hormone-releasing hormone (GHRH).
The posterior region is used for regulating body temperature (sweating and shivering) and potentially also for memory function.
For a tiny region in the brain that is the size of a pea and accounts for less than 1% of the brains weight, this is a heavy load of tasks to be ruling over.
There is a clear reason why the hypothalamus is referred to as the master control centre or the master gland.
A big part of the hypothalamus’ role is making decisions based on the feedback that it is getting. Because it has control over so many areas, it takes a big picture view and decides what is best for survival. Based on this assessment, it increases or curtails various hormones, which have downstream impacts on the functioning of all systems in the body.
For so many of the clients that I work with (and plenty of people who read the blog and listen to the podcast), their focus on the hypothalamus is fairly narrow. They have hypothalamic amenorrhea, which is when their period has ceased and the cause is the hypothalamus.
Their focus is on supporting their body so they can get their period back. There is often an understanding that the situation is more than just about a missing period, that there are other implications. But I’m not sure if there is a complete recognition of just how wide-reaching this impact is.
Let me use an example to demonstrate.
We have someone who struggles with food. They’re restricted in what they eat – both in terms of quantity and variety. They have their list of safe foods and if they can help it, they won’t deviate from it.
They are also exercising regularly. It used to be more and this is something that they can’t help but compare themselves to. But irrespective of this, they are still over-exercising for their current state because of insufficient calories coming in and the difficulty they have taking time off.
Given the restriction and the exercise, they are underweight for where their body wants to be. This doesn’t necessarily mean that they are underweight based on BMI, but compared to where their body wants to be, they are under this point.
With a scenario like this, what is the hypothalamus going to do? Given its focus is on survival, what choices does it make?
The hypothalamus will push for increased stress hormones. Being undernourished and over-exercised is a stress on the body in and of itself and one of the roles of the stress response is to find energy.
It can do this by pulling out carbohydrates that have been stored for emergencies and for keeping us going between meals (known as glycogen). Or if this isn’t available, it can start breaking down muscle, bones, organs and other tissues.
The hypothalamus will push for a downturn in thyroid function. The thyroid has a large impact on the rate that energy is being used. When the available energy is reduced, spending also needs to be pulled down.
The knock-on with this one is wide-reaching. For example, if there is less energy going to digestion, it will be impaired and symptoms will arise. The same is true with all systems because thyroid hormones affect every cell and all the organs of the body.
The hypothalamus will suggest a reduction in reproductive importance. There’s not enough energy to run the everyday tasks and that’s before the demands of growing a human being. This leads to a downturn in reproductive hormones, often to the point that periods completely cease.
The hypothalamus will reduce growth and repair. There is insufficient energy to meet the demands of today, further building works are not important right now.
The hypothalamus will make you hungrier and need bigger meals to reach a point of satisfaction. It is trying to get you to eat more food and by increasing your thoughts and drive towards food, it hopes this will happen.
(Obviously, this doesn’t always work. As I cover in this article, hunger can often be ignored or the symptoms chalked up to other reasons).
All of the above changes are a direct result of changes made by the hypothalamus. But really, this is just the start of it. Because the knock-on effect means that many other downstream changes lead to further symptoms. Things like:
When I add all these symptoms together, we have a list of the most common symptoms experienced in disordered eating and eating disorders. And they are all connected to the hypothalamus (either directly or indirectly).
Part of the reason for writing this piece is because this is what I often see occurring with those who have suffered from hypothalamic amenorrhea.
When your period goes missing it can be a clear sign that things aren’t working as they should be. If the body isn’t prioritising reproduction its an indication of the state the body is in.
But is the opposite true? If someone gets their period back, does this mean that everything is back to normal? That full health has been restored? For many people, it feels like this is the assumption. That if menstruation is occurring, everything is good as it should be.
From my perspective, I don’t necessarily see this as true.
We are all wired differently. For some people, it takes a lot to lose their period. Despite being in a clear deficit and many other systems failing, they are still able to menstruate. It’s only much later that it disappears. (Part of this could be because of anovulatory cycles, something I talk about here.)
And the same can be true in the order of healing. Their period can return fairly early when there is still vast amounts of repair and recovery to be done.
You can then have someone sitting at the other end of the spectrum. Their period is the first thing to go, much earlier than many other symptoms occurring. Then, during recovery, it is one of the last things to return.
Reproduction, like so many things within the body, is on a continuum.
So rather than menstruation being this verifiable truth that full recovery has occurred, it should be seen as just one data point.
Because typically it’s not the point of completion and there are many other symptoms (like the ones mentioned earlier) that can indicate that more work is to be done.
Using symptoms and feedback from the body is a great way of assessing where the body is at. It can be helpful in a broader sense, but also when making changes, by seeing what happens (note: symptoms aren’t linear and don’t always improve immediately, even when you are making changes that are supportive to health).
When looking at symptoms, we should be looking at many at once. There is no “one symptom to rule them all” to use a Lord Of Rings Analogy. It’s systems thinking, rather than thinking about parts in isolation.
If you’d like help getting your period back, in combination with the healing of the body as a whole, I’d love to help. I truly believe that you can reach a place where the eating disorder is a thing of the past and I want to help you get there.
I’m a leading expert and advocate for full recovery. I’ve been working with clients for over 15 years and understand what needs to happen to recover.
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