Hypothalamic Amenorrhea
What is Hypothalamic Amenorrhea?
Hypothalamic Amenorrhea, or HA, is a form of chronic lack of menstruation, often associated with three main underlying causes: weight loss, excessive exercise, stress, or any combination of these. Regardless of the cause, HA is caused by interruptions in the hormonal communication between an axis involving the hypothalamus, pituitary, and ovaries which is necessary to support normal reproductive function. The hypothalamus is in the center of the brain and helps controls reproduction. It produces GnRH, or gonadotropin-releasing hormone, which signals the production of other hormones needed for ovulation. GnRH causes the ovaries to make estrogen and progesterone and is responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland, which are both important for ovulation. Fluctuations of this HPO axis can cause changes in the hormones produced by each gland and have various effects on the body. Reduced GnRH function results in decreased LH and FSH levels to a point where the body cannot maintain full ovulatory function, which can cause anovulation and ultimately infertility.
Hypothalamic Amenorrhea may be due to certain lifestyle factors including weight loss, excessive exercise, and/or stress. Why is that?
Weight loss. Being underweight or quickly losing a substantial amount of weight may interrupt many hormonal functions in your body, which can seize ovulation. Women who struggle with disordered eating behaviors, such as anorexia, bulimia, or orthorexia may experience a loss of their period due to abnormal hormonal changes.
Excessive exercise. Women who participate in rigorous training including running, ballet, or other related athletic activities may find their menstrual cycles interrupted. This can be attributed to low body fat, stress, and/or high energy expenditure in this athletic population.
Stress. We now know that the hypothalamus plays a huge role in your reproductive functions. Mental stress can temporarily alter the functioning of your hypothalamus. Ovulation and menstruation may stop as a result of this.
Treatment:
Symptoms and conditions related to amenorrhea are usually reversible and treatable. In order to restore menstruation, it is often recommended that the energy imbalance caused either by stress, weight loss, or vigorous exercise be corrected to improve HPO axis function. Treatment will vary depending on the cause. Talk to your primary care physician about your options and consider asking for a referral to a Registered Dietitian. Treatment may include increased caloric consumption, and/or improved nutrition, and/or decreased or modified exercise and will often require weight gain. It may also be suggested not to use oral contraceptive pills in order to regain menses and improve bone mineral density.
Check out these additional resources to help you better understand HA:
https://www.avawomen.com/avaworld/im-really-healthy-except-i-dont-get-my-period-2/
https://flo.health/menstrual-cycle/health/period/hypothalamic-amenorrhea
https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/causes
Handout by Ariana Wood and Hillary Wright, MEd, RN, LDN
References:
Catherine M. Gordon, Kathryn E. Ackerman, Sarah L. Berga, Jay R. Kaplan, George Mastorakos, Madhusmita Misra, M. Hassan Murad, Nanette F. Santoro, Michelle P. Warren, Functional Hypothalamic Amenorrhea: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, Volume 102, Issue 5, 1 May 2017, Pages 1413–1439, https://doi.org/10.1210/jc.2017-00131
Harvard Health Publishing. Amenorrhea. Harvard Health.
Hypothalamic-pituitary-ovarian axis. Straight Healthcare. https://www.straighthealthcare.com/hypothalamic-pituitary-ovarian-axis.html. Accessed April 22, 2019.https://www.health.harvard.edu/a_to_z/amenorrhea-a-to-z. Accessed April 20, 2019.
Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M. Functional hypothalamic amenorrhea and its influence on women's health. Journal of endocrinological investigation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207953/. Published 2014. Accessed April 21, 2019.
What causes amenorrhea? Eunice Kennedy Shriver National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/causes. Accessed April 20, 2019.