“Bikini Competitor Syndrome” aka Hypothalamic Amenorrhea
Updated: Jun 29
The rise of Crossfit, Fitness oriented Instagram accounts and the increased popularity of bikini and physique competitions have contributed to the distorted fascination among women to be ultra-lean and shredded all the time. Toss in some chronic over exercising and what’s left is a full-blown epidemic of Functional Hypothalamic Amenorrhea or loss of menstruation.
The state of the fitness industry has created an opportunity for unqualified “Insta” prep coaches and untrained CrossFit coaches to take advantage of first-time competitors or fitness enthusiasts by offering “nutrition coaching”. This is the main cause of metabolic dysfunction seen in the female fitness population. This same “coaching” is what leads to compromised health and the return of initial body weight plus additional body fat post show aka “post show rebound” but it doesn’t have to be that way.
What is Hypothalamic Amenorrhea?
Functional Hypothalamic Amenorrhea (FHA) is the medical term used to describe dysfunction of the HPT axis which causes irregular or loss of the menstrual cycle and thyroid hormones. This occurs when the body and brain are in a state of stress. Everyone has a friend who doesn’t get her period. It can be due to disordered eating or because she’s a cardio queen racking up more hours on the treadmill than a full-time job.
So often these days we starve ourselves in pursuit of slimming down, and over train in an effort of winning gold at our next show, or CrossFit competition, and while these may all be valid short-term pursuits, ongoing overtraining and undernourishment can lead to more severe complications from FHA. Some additional adverse effects include: elevated cortisol, decreased bone density, depression and anxiety, sexual problems,2 skin issues, low energy, erratic hunger, always feeling cold, and brittle hair and nails.
What Causes Hypothalamic Amenorrhea?
There are three main causes of FHA but you can also have a combination of all three. They are:
1. Weight loss-either drastic or slowly over time
2. Stress-from work, family, illness etc.
3. Over Exercise- too much, too often or both
Women lose their period due from inadequate food or macronutrient intake (LOW OR NO CARB diets), excessive weight loss (crash dieting to make a show date), low body fat percentage, and over exercising (if you’re doing more than a few hours of cardio a week YOU’RE EATING TOO MUCH!) all in an effort to achieve what is biologically an unnatural amount of body fat and body shape.
The short answer is to exercise less and eat more; these two simple fixes lay the foundation for recovery from FHA. I know, being told to eat more and exercise less is a scary as hell! If you truly want to be healthy, it all begins on the inside. If you are willing to take trust the process, there are a number of ways to make recovery from FHA less stressful. Treatment of hypothalamic disorders should start with eliminating emotional strain, avoidance of stressors, reduction of exercise, and/or optimization of body composition.3
There are three main solutions for FHA:
A patient presenting with high cortisol levels requires stress reduction measures and/or cessation of extra exercise such as cardio, interval training or a reduction in weight training coupled with additional rest days.
A patient who is underfed and underweight requires reverse dieting until they are consuming a healthy number of calories and optimal hormone production resumes.
A patient presenting with low thyroid production, specifically T3, require an increased carbohydrate intake and an increase in total calories. Other thyroid labs out of range should be individually addressed.
It can be your partner, your best friend, a naturopath or clinical nutritionist, it is important that you find someone who understands just how challenging this will be for you and who can hold you accountable to ‘your plan’.
Make A Plan
Whether you are a bikini competitor, CrossFit or endurance athlete it is highly likely that you love a structured eating plan, training schedule and routine. Recovery from FHA is no different than prepping for your next competition. It requires the same amount of planning, effort and determination to follow a program that includes an appropriate amount of exercise, a healthy nutrition plan and ample recovery time. This may take up to a year in some woman to resolve.
Contrary to popular belief, carbs are not the devil. In fact, when it comes to healing the thyroid and regulating the function of the pituitary gland, dietary carbs (in whole, unprocessed forms) have proven to be greatly beneficial. This is because carbs such as sweet potato, yams, brown rice, quinoa and other ancient grains cause the release of insulin within the body, sending a signal to the brain that food is being received and we are not starving.
Fear No Fat
Healthy, unprocessed fats such as those found in avocados, nuts, grass-fed butter and coconut oil, are one of the most nourishing and nutrient dense foods that we can consume in our diet. By including a good amount of healthy fat with every meal we give the body the raw material to make hormones which are depleted with FHA.
High Quality Protein
When we are looking to maximize our hormonal function, it is vitally important to source the highest quality protein available such as grass-fed, organic meats, free-range chicken and pastured eggs and wild caught fish or super clean grass-fed and naturally sweetened protein powders. Factory farmed and commercially raised animals are often consuming corn, soy and chemicals that not only wreak havoc on their hormones but also carry hormone disrupting chemicals in their flesh that are consumed and poorly digested. Look for animals fed their natural diet. IFBB Pro and Nutritionist John Meadows likes to say, “You are what you eat, eats.”
Reduce Unnecessary Exercise
Your days of tossing weights around set after set like a cage gorilla on 4 scoops of pre-workout are over! A reduction in unnecessary and excessive exercise is absolutely essential in your recovery from FHA because you’re driving your body deeper into a state of stress. There is no definitive exercise prescription, but a reduction is essential. Stopping entirely isn’t great either, that simply wouldn’t be healthy for the body or the mind.
Instead of the usual ‘daily grind’ opt for more restorative forms of exercise such as yoga, Pilates, or easy hiking. Do your best to minimize prolonged cardio and reduce weight training to short sessions 2-3 times per week.
Chronic stress has become the norm for our society today, with mental stress having one of the most powerful and negative impacts on female reproductive function. While it can be challenging to accept the notion that we actually require time to rest and restore, it is absolutely essential to making a full recovery. One of our favorite ways to decrease stress include yoga, meditation, hiking in nature, sex, deep belly breathing, gratitude journaling, or a hot tub and glass of wine.
Prevention is key
Potential competitors and competitors alike need to be responsible and do their own research when selecting a nutritionist, coach or trainer. Ask for credentials, speak to past clients, and ask A LOT of questions. It’s not difficult get someone into contest shape but it’s entirely different to bring them into a show healthy, still going through a normal menstrual cycle, and then bringing them out of a show to a fully functioning, healthy metabolism.
As a clinical nutritionist, I see a growing number of women, both competitors and non-competitors, with this condition and it’s quite concerning. Unfortunately, too many of them end up as patients in my office with health problems ranging from anemia, hypothalamic amenorrhea, other HPTA dysfunction, compromised gut health and IBS.
In the majority of cases, these health risks could have been prevented had they had done some research. Proper nutritional counseling and exercise prescriptions are critical for optimal health and will lead to outstanding results for the person looking to place competitively in bikini or CrossFit competitions.
Meczekalski, B et al. Functional hypothalamic amenrrhear: current view on neuroendocrine aberrations. Gynecol Endocrinol. 2008 Jan;24(1) 4-11.
Starka, L, Dusova M. Functional hypothalamic amenorrhea. Vnitr Lek. 2015 Oct 6 1 (10):8825
Sowinska-Przepiera E, et al. Functional hypothalamic amenorrhoea — diagnostic challenges, monitoring, and treatment. Endokrynol Pol. 2015;6(3):252-60.