Hypothalamic Amenorrhea

The medical term for missing periods (for longer than three months) is Amenorrhea. Secondary amenorrhea is when a woman who previously menstruated on a regular basis misses her periods for six months and longer.

The absence of menses is a sign of a body that is out of balance. It is a rather common problem, but it is NOT normal. The diagnosis vary, and can include PCOS, hypothalamic amenorrhoea, premature ovarian failure, peri-menopause, hyperprolactinaemia and more.

These conditions can cause erratic, unpredictable or totally absent cycles.

To be able to address the issue of irregular or absent periods, it is necessary to have an accurate diagnosis. This should be done by a health care professional, and this post is only meant to be informative and provide a basic understanding.

The most common form of secondary amenorrhea is Hypothalamic Amenorrhea (HA), a condition often related to stress and a restricted energy intake.

HA is a reversible disorder in which no anatomic or organic abnormalities of the hypothalamic–pituitary–ovarian axis can be identified. HA the most common on cause of secondary amenorrhea , responsible for approximately 35% of cases.

Physical and emotional stress affect the functioning of the hypothalamus, which connects the brain to the endocrine system. When under stress, the hypothalamus goes to sleep, halting the production of gonadotropin-releasing hormone (GnRH). GnRH signals the ovaries to produce estrogen, among other things. Without estrogen, ovulation and menstruation stop.

The term "functional" in functional hypothalamic amenorrhea implies that the ovulatory ovarian dysfunction is reversible with correction of the underlying cause.

Often, the stressors are a combination of restricted food intake, excessive exercise (which will be a different amount for different people), and mental and emotional stress.

PCOS OR HA?

Two conditions that can both cause amenorrhea and that have been commonly confused confused are polycystic ovarian syndrome (PCOS) and functional hypothalamic amenorrhoea (FHA).

Polycystic ovarian syndrome is a condition characterised by menstrual irregularities associated with insulin resistance or hyperandrogenism (raised male sex hormones, such as testosterone). PCOS often presents itself through symptoms such as weight gain (or difficulty losing weight), hair loss, acne, hair growth on the face and polycystic ovaries on ultrasound. Infrequent or absent periods are another possible sign of PCOS, due to the body inability to ovulate regularly. 

On the other side, hypothalamic amenorrhoea occurs when the brain stops communicating with the ovaries, which results in an absent or irregular menstrual cycle. Some of the most common causes of FHA are directly related to lifestyle; stress, inadequate food intake (and nutrient intake), too much exercise, and often a combination of all three. The body believes and recognises that it is not “safe” or even healthy, therefore it is not in a state where it will be fertile.
Other symptoms of HA include depression and anxiety, low libido, feeling cold and experiencing low energy levels. 

PCOS and HA can present themselves with similar symptoms, yet the treatment of the two are often quite the opposite. Both conditions can be treated, as they are not chronic conditions.

PCOS requires a specific blood-sugar balancing diet and lifestyle appropriate to the individual. Movement is often recommended. HA, on the other hand, usually requires the individual to slow down, rest more, stress less, and eat MORE. Weight gain might also be necessary.

Because the treatment for PCOS and HA is so different, accurate diagnosis is important. 

A regular menstrual cycle is an important sign of health in women. Prolonged amenorrhoea can is also associated with undesirable effects such as bone density loss and osteoporosis, fertility issues and more.

For these reasons, and more, it is important that we don’t normalise having absent or irregular periods.