Hypothalamic amenorrhea (HA) is when your menstrual cycle and ovulation are interrupted due to the influence of the hypothalamus gland, located in the brain.  In this article we run through common symptoms, the causes and treatment options available.

Quick facts:

• The hypothalamus gland, in the brain, can be affected by stress, low weight and excessive exercise. 
• Hormones the hypothalamus produces are involved in regulating your sex hormones. 
• If your sex hormones are disrupted, your menstrual cycle won’t function properly. 
• Symptoms include missed periods, low sex drive, low energy and more.
• Testing your hormones is the first step toward getting a diagnosis.

What causes hypothalamic amenorrhea?

The hypothalamus is a small region of the brain that plays a crucial role in lots of important bodily functions. It controls the release of certain hormone and helps to regulate body temperature, sleep patterns, hunger and the menstrual cycle. 

It is a commonly occurring condition in women with eating disorders, athletes or dancers or those with a low body mass index (BMI)

Hypothalamic amenorrhea is caused specifically by issues in the functioning of the hypothalamus. The function of the hypothalamus can be disrupted by lots of different things, usually lifestyle factors. 

Common disruptors include:

• Excessive exercise
• Eating disorders such as anorexia or bulimia
• Malnourishment
• Being underweight
• Being on a calorie-restrictive diet
• Psychological stress
• Substantial weight fluctuations.  

Symptoms of hypothalamic amenorrhea

Common symptoms include:

• Irregular or no period(s) 
• Very light periods
• Low sex drive
• Feeling cold often
• Mental health issues including depression and anxiety
• Difficulty sleeping
• Increased hunger
• Low energy

What causes menstrual cycle disruption

When you eat too little or exercise too much, the body perceives this as stress. This can lead to severe fluctuations in a hormone called gonadotropin-releasing hormone (GnRH). This is the main hormone regulated by the hypothalamus. 

GnRH influences the production of other hormones, including those involved in the regulation of the menstrual cycle. 

Follicle-stimulating hormone (FSH), needed to mature an egg each cycle and luteinising hormone (LH), needed for the release of the mature egg each cycle, can become disrupted as they both rely on GnRH. 

FSH and LH, in turn, regulate oestrogen and progesterone production by the ovaries. Oestrogen helps the eggs to mature and progesterone prepares the uterus lining for a fertilised egg.

Typically, a rise and fall in FSH, LH, oestrogen and progesterone is what controls the menstrual cycle. If a disruption happens at the hypothalamic level, the hormonal cascade is affected, resulting in low FSH, LH and oestrogen.

Essentially, this is just your body trying to protect you. It’s putting your basic energy needs ahead of your reproductive health, which is why your periods become irregular.

How can hypothalamic amenorrhea be diagnosed?

It is usually a “diagnosis of exclusion,” which requires healthcare providers to rule out other conditions that could be interrupting the menstrual cycle. Your doctor may consider the following blood hormone tests to base their diagnosis on: 

• Gonadotropin-releasing hormone (GnRH) 
• Follicle-stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Estrogen (E2)
• Thyroid-stimulating hormone (TSH)
• Prolactin
• Testosterone
• Human chorionic gonadotropin (hCG)

GnRH levels are tested to analyse the function of the hypothalamus, with a low GnRH result being indicative of a dysfunctional hypothalamus. Low levels of FSH, LH and E2, may also indicate hypothalamic amenorrhea. 

High levels of prolactin can also lead to irregular or absent periods. Testosterone levels are analysed to eliminate the possibility of hyperandrogenism (high androgen levels) and  Polycystic Ovary Syndrome (PCOS). 

Thyroid-stimulating hormone is analysed to rule out the influence of thyroid gland disorders. Human chorionic gonadotropin is purely tested to confirm or eliminate the possibility of pregnancy influencing your periods.

Hypothalamic amenorrhea treatments

If you’ve received a diagnosis of hypothalamic amenorrhea, your pathway to care and treatment options will usually be tailored according to the cause.

Healthy lifestyle habits, diet and exercise routine modifications can help improve your symptoms, and make them more manageable. If you think you may be experiencing any of the symptoms above, reach out to us. 

Hertility can help you with your initial hormone testing, along with a comprehensive Doctor-written report analysing your results. We can also support you with any onward care or treatments you may need, including tele-consultations with specialists. 

Resources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207953/