Hypothalamic amenorrhea (HA) is when your menstrual cycle and ovulation are interrupted due to the influence of the hypothalamus gland, located in the brain. It is a commonly occurring condition in women with eating disorders,athletes or dancers or those with a low body mass index (BMI).

What causes hypothalamic amenorrhea?

The hypothalamus is a small region of the brain that plays a crucial role in many important functions, including the release of hormones, regulating body temperature. sleep, hunger and the menstrual cycle. Hypothalamic amenorrhea is caused by issues in the functioning of the hypothalamus. 

Common causes include:

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

When you eat too little or exercise too much, the body perceives this as stress. It leads to severe fluctuations in the hypothalamic hormone, gonadotropin-releasing hormone (GnRH). This hormone influences the production of other hormones which are needed for the egg to mature, such as follicle-stimulating hormone (FSH) and for the release of the mature egg from the ovary during ovulation, such as luteinising hormone (LH). FSH and LH, in turn, regulate oestrogen and progesterone production by the ovaries. Oestrogen thins the cervical mucus and progesterone prepare the uterus lining for a fertilised egg.

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

Symptoms of hypothalamic amenorrhea: 

Common symptoms include:

  • Missed period(s) or very light bleeding during menstruation;
  • Low libido;
  • Feeling cold often;
  • Mental health issues including depression and anxiety;
  • Difficulty sleeping;
  • Increased hunger;
  • Low energy.

It is just your body trying to protect you, by putting 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 hormones tests to base their diagnose 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; low GnRH is indicative of a dysfunctional hypothalamus. Low levels of FSH, LH and E2, may indicate hypothalamic amenorrhea. High levels of prolactin may suggest a pituitary gland tumour, which could be leading to amenorrhea. Testosterone levels are analysed to eliminate the possibility of Polycystic ovary syndrome (PCOS). Thyroid-stimulating hormone is analysed to rule out the influence of thyroid gland disorders on your period. Human chorionic gonadotropin is purely tested to confirm or eliminate the possibility of pregnancy influencing your periods.   

How can it be treated?

If your reports are indicative of hypothalamic amenorrhea, your pathway to care and treatment options will usually be tailored according to the cause and reproductive concerns. 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, we can help! Testing your hormones can be a looking glass into your reproductive and overall health. But at Hertility, we don’t believe in giving you results without the rest. Our team of experts can help to put you on the path to restoring your period and improving your overall health and fertility.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4207953/
https://www.stgeorges.nhs.uk/wp-content/uploads/2013/11/Amenorrhoea.pdf