In a previous article, I discussed the differences between hypothalamic amenorrhea and PCOS. There, I talked about the importance of having the correct diagnosis because the treatment options are in complete opposition. For PCOS, you will be advised to diet, reduce carbs and workout more. HA requires the opposite approach – eating more, exercising less. You can see how the wrong diagnosis will throw you even deeper into your problems.

Hypothalamic amenorrhea and PCOS can coexist

There’s an even bigger issue though. Hypothalamic amenorrhea and PCOS can actually coexist. Yes, you read that right! How is that possible? Well, the first scenario is a woman diagnosed with PCOS who is told she must lose weight at all costs. So she starts exercising, cutting calories, limiting carbs. On top of that, she also has a normal job, hobbies, family. She sees results so she pushes further. And further. Until it’s too much. See, the problem is doctors will rarely tell a PCOS patient to stop dieting/exercising. It is also true that women with insulin-resistant PCOS will have a harder time losing weight, and many will make drastic changes to their diet and lifestyle. But that doesn’t mean that those drastic lifestyle changes cannot lead to hypothalamic amenorrhea.

Lifestyle changes for treating PCOS can lead to hypothalamic amenorrhea

How can you tell you have both HA and PCOS?

I won’t lie, it is difficult. The more research is done, the more the two conditions feel hard to differentiate. Until now, high testosterone or high LH was enough to say it is definitely PCOS and not HA. Now, more studies show it is possible to have HA despite elevated LH or even testosterone levels.

Lifestyle must be taken into account when diagnosing. If you lost a lot of weight in a very short period of time, if you are exercising more, feeling stressed, and tired, and on top of that you’ve lost your period, HA is a possibility. If your periods were already irregular/missing because of PCOS, seeing the difference might be harder. Again, analyzing lifestyle is key! One thing you could do is check if your insulin resistance is reduced. This should be your primary goal when treating PCOS. Addressing the insulin resistance will usually result in more ovulatory cycles. If you’ve addressed and maybe even reversed your insulin resistance but your period is MIA, functional hypothalamic amenorrhea might be the issue.

The risk of using the pill with hypothalamic amenorrhea

If you go on birth control without a diagnosis, as many women do, and you actually have hypothalamic amenorrhea, you are worsening your issue. This is because you will most likely not address the cause of HA, but you will keep living in the same way. The even bigger risk is developing post-pill PCOS when you quit the pill. This should be easier to resolve, at least because, with proper care, post-pill PCOS should subside in about a year. However, this situation can be difficult in itself. The easiest way to differentiate between real PCOS and post-pill is answering the question “did your symptoms exist before the pill?”. If you answer yes, you are thrown into the “real PCOS” category.

But what if you went on the pill based on the above scenario, having hypothalamic amenorrhea without knowing? In this case, you might end up with the worst situation – having both conditions at the same time.

When having both conditions, blood work can be confusing

I find treatment, in this case, to be fairly difficult. Hopefully, blood work will be helpful and reveal the real cause of the amenorrhea. However, we already know that temporary androgen surges can happen when quitting hormonal birth control. A high LH is also not necessarily indicative of PCOS, just like polycystic ovaries are not enough for a diagnosis. Further discussion needs to take into consideration a person’s full history. Did you have an eating disorder? Did you have any major stress in your life, around the time of puberty? These and many other questions can help reveal the presence of hypothalamic amenorrhea. If insulin resistance does not exist, I find the best thing to do is to adopt an anti-inflammatory diet but to NOT restrict calories. In other words, address HA first, without forgetting about PCOS.


The easiest method to avoid having both PCOS and HA is prevention. If you recognized yourself in the last scenario, you probably didn’t have much choice, as you might have been put on the pill at a young age. You can prevent doing more damage, by falling into the trap of restricting your diet even more to “help” with PCOS.

If you are someone who has PCOS, maybe someone who is also overweight, paying close attention to prevention is crucial. Here are some tips that can help:

  • If you must restrict carbs for insulin resistance, make sure you increase healthy fats and protein. Going low carb is already a big change for most people. So start small, don’t try to eliminate and restrict everything at once. You decided to start with carbs – very good, that means you will give up most junk foods and sugars. So don’t start limiting protein or fats as well. Also, try not to go too low calorie. Again, focus on low carb, but eat an amount of food that makes you feel satisfied. If you start craving sweets, feel tired all the time, or experience mood swings, it could be a sign you’re overdoing it and have reduced calories too much. Add some!
  • Be mindful of how much exercise you add. If you are a couch potato, don’t go to doing HIIT 6 days a week. You might lose weight but with it, also your period. If you are a beginner, start with exercises suitable for you. Light aerobic exercises and strength building. It doesn’t matter if all you feel comfortable with are 2-pound weights. It is still more than 0!
  • Don’t forget to also relax. Constantly trying to change your diet and add more exercise can leave you feeling depleted. While exercise can be a great means of stress relief, it can also be the opposite, especially if you are overdoing it.

It all comes back to the 3 pillars of hormonal health

Food, exercise, and stress management truly are the 3 pillars of hormonal health regardless of your problem. PCOS, HA, endometriosis, they can all find at least some relief, if not a cure, by balancing these 3 pillars.

Start by addressing your diet – make sure it’s balanced, with limited junk and processed foods, that it contains enough fats, protein, and carbs (no need to fear carbs if you’re not insulin resistant).

Move your body! Do it in a way that is fun, easy, yet a bit challenging, just enough to bring you satisfaction, make you feel like a champion, but leave you with enough energy to celebrate your achievement.

Finally, don’t forget to relax and take it easy! Rome wasn’t built in a day! Hormonal health, like most things in life, takes work and needs endurance. Don’t add stress by pushing your body way beyond its limits. Self-care and stress management are just as important for hormonal health as diet and exercise. It doesn’t matter if you excel in one or two of them but fail in the third one. Balance them all.

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