dance health, Eating disorder / disordered eating, Menstrual cycle

Functional Hypothalamic Amenorrhoea (FHA) – Information and Treatment for Dancers



Amenorrhea is the term used to describe the absence of a period

It’s a natural occurrence in pregnancy. Otherwise, a sudden change or stop in your period means that your body is asking you for help because it’s not coping.


When your menses don’t commence by the age of 16, it is termed Primary amenorrhoea.

When your period stops for more than 3 months sometime after menarche, it is terms Secondary amenorrhoea.

When your period cycle is irregular and they ccue at intervals longer than 35 days, it is termed Oligomenorrhoea.


Functional Hypothalamic Amenorrhoea (FHA) is a type of Secondary Amenorrhoea and is diagnosed after excluding all other causes of amenorrhoea. The period stops because of an issue at the hypothalamus, the centre of the brain where it controls reproduction. Its main causes are:

  1. Low energy availability (not eating enough to meet your training needs)
  2. Weight loss and/or low body weight
  3. Excessive exercise (the “normal” training load for dancers are often considered “excessive” for the body)
  4. Stress (physical or psychological)


As you can see, it’s a very common situation that any dancer can slip into.



In ballet dancers, especially those training hard from a young age, it’s not uncommon to see a delay in menarche (first period), most often due to the intense physical training and subsequent negative energy balance.


The occurrence of sescondary amenorrhoea can be up to around 69% in dancers. Again, the main cause is the intense physical training which leads to negative enrgy balance.


Even though a dancer may ‘look’ healthy, sudden increase in training (e.g. starting full-time dance training) or decrease in energy intake (e.g. dieting, illness) can reduce the body fat percentage too low. This leads to reduction in oestrogen production.


This is dangerous because oestrogen is such a crucial hormone in maintaining bone health and reproductive health.


How do I treat FHA?

  1. Eat more to provide more nourishment to your body
  2. Reduce the training load

Your body will also need to restore weight especially if you’ve experienced significant reduction in body/fat mass.

You will also need to develop stress-coping skills.


Q. What happens if I don’t treat FHA?

FHA can lead to less production of oestrogen. This is an issue because oestrogen helps prevent bone loss, so having less oestrogen production means you may be at higher risk of osteoporosis or osteopoenia. Lack of oestrogen can also put you at risk of heart diseases.

Which all means that, if FHA is left untreated, your body will become weaker. That means more risks of injuries (e.g. stress fractures), more time to heal from injuries, impaired recovery, less training adaptations and overall drop in your performance.


Q. Are there other treatment options?

Eating more to replenish your energy and nutrient stores; reducing training load so that the physical stress on your body is less; restoring weight; and stress management are the core treatment options.

Your doctor may prescribe you with oral contraceptive (hormonal) pills. However, these are not “the cure” for FHA and may not protect you from bone density loss that was initially thought to provide. Unless you correct your energy availability that’s at the heart of this, you will continue to have the risks and dangers assoiated with FHA.


Q. “But my friend is skinnier than me and she has regular periods. Why do I have to eat more and gain weight?”

Yes, I hear you.

It’s frustrating isn’t it.

The thing is this:

If you have FHA, your body has shut down its reproductive system because it sensed that it’s in danger for survival.

The energy coming in isn’t enough to cover the energy being used for living and training/dancing, which means that eventually it may starve to death.

Your energy and nutrient needs are different to your friend, your sister, your teacher, your mum, and anyone else in the world.

Comparing your situation and needs to your friend won’t help you hear because you are unique and your needs are unique too.




“Eating more” may at first seem scary or feel uncomfortable, especially if you’ve been commented on your body weight or size in the past.

But your body is I M P O R T A N T and it deserves 100% of care, which is to be nourished.


Fumi x



  • Márquez S and Molinero O. Energy availability, menstrual dysfunction and bone health in sports;an overwiew of the female athlete triad.
  • Lopez LM, Grimes DA, Schulz KF., Curtis KM. and Chen M. Hormonal contraceptives and bone health in women.



The cause(s) of amenorrhoea varies. It can be due to prolonged energy or nutrition deficit, low body weight or fat mass (due to energy deficit), hormonal imbalance, medical conditions such as PCOS (polycystic ovarian syndrome), physical damage in/to do the reproductive system, or chromosomal abnormalities (this one is very rare). It’s important to see your doctor to go through appropriate testing so that you get the right treatment quickly and effectively.

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