Nicola Rinaldi, PhD: No Period Now What – Healing Hypothalamic Amenorrhea and Managing Fertility

February 8, 2017


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On this show we’re joined by Nicola Rinaldi, PhD, an expert on hypothalamic amenorrhea and author of No Period Now What, who’s here to talk all about why we lose our periods, how to regain a missing period and how to live a healthy, fertile life whether or not kids are a goal. This talk dives heavily into the research that’s available as well.

Defining hypothalamic amenorrhea (HA) and risk factors

  • The network of hormones that communicate and control our cycles and fertility starting with our actions and the hypothalamus.
  • Variables that lead to decreased communication in reproductive hormones.
  • Quote from the book, highlighted by Tawnee: “No matter what our conscious minds think, if our hypothalamus senses an unfavorable nutrient balance or stress environment, it will shut down the ability to cycle and procreate.”
  • Nicola’s story of losing then regaining her period and fertility.
  • It’s important to point out this doesn’t just happen to high-level athletes!
  • What are tall-tell signs one is at risk whether it’s an unhealthy approach to exercise, food, body image, stress or all of the above – maybe some women don’t even realize they’re harming themselves.
  • 5 risk factors:
    • Low body fat
    • Decreased food intake
    • Constant hunger
    • Stress
    • Exercise
  • Is the #1 factor in HA is lack of energy availability?
  • HA women have higher levels of perfectionism.
  • Exercise obsession – how much is too much?
  • How come some girls can handle more and still get a period?


  • What is PCOS, how does it differ from HA, and how women can figure out if they have PCOS or HA. Similarities and differences.
  • Must have two of three specific symptoms for it to be PCOS.

Why is HA unhealthy as is using BC to “fix” it? 

  • The potential consequences beyond brittle bones and infertility.
  • Predisposition to heart disease.
  • Cognitive decline.
  • BMI numbers associated with losing a period.
  • Birth control (BC) pills are not an accurate indicator of health.
  • Thoughts on using BC to get and maintain a period that might not be present otherwise.
  • Nicola’s take: Be on BC and get an “artificial” period or get off BC and have no period? (For those gals aren’t quite ready to do the work to get back the period naturally.)

HA recovery

  • The recommended steps for women to take.
  • Who to see: a conventional doctor, naturopath, health coach, etc.? Healing on your own?
  • Eating recommendations for healing and how to adopt a healthy mindset and ditch restrictions in the process.
  • Thoughts on supplementing with bioidentical progesterone or other supplements like estrogen, chasteberry, etc., as a way to speed the recovery process?
  • Is hormone testing of some kind is needed?
  • In healing phase, thoughts on decreasing exercise and by how much? Some studies show if food is adequate (thus EA) maybe a decrease in exercise isn’t as necessary.
  • Tawnee’s personal story on regaining her period and how she had to decrease exercise to not just because of the phyiscal stress but the mental stress she had toward sport at the time.
  • What other variables go into healing such as stress management. How can girls like us ditch the stress when it’s so programmed in our blood and DNA??
  • What if it’s not working – still no period?! What to do?
  • Thoughts on Clomid or Femara as treatment for normal menstruation and ovulation.
  • What’s the normal BMI for women to get to for having a period with normal ovulation and luteal phases, and if it’s a goal, pregnancy?

Making a return to training/exercise

  • Women who’ve recovered from HA: What’s next?
  • Are we able to resume an exercise program and keep a normal period?


  • Other issues like ongoing low progesterone and luteal phase defect.
  • How does a history of HA affect future fertility? Do women with history of HA struggle to get pregnant? Does the duration of HA make a difference i.e. 6 months vs 10 years of HA?
  • How long should you recover from HA or what signs should you see before it’s time to try to get pregnant?
  • Doing all we can for the health of the unborn baby – what can we do to make sure we’re building a “palace” for our little ones and not letting our own exercise/food addictions take over and cause us to stay too lean before/during a pregnancy?
  • More and more women are exercising during pregnancies at levels even doc’s didn’t traditionally advise, but if you have history of HA should you be more careful with exercise before/during pregnancy?

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