If you are here, you are likely wondering why your period has gone missing. You aren’t pregnant, you don’t have any health issues that you know of. Nevertheless, your period has been missing for months or even years. Perhaps I can offer you an answer. In this article I explain a condition called Hypothalamic Amenorrhea, one of the common causes of missing periods. I will also outline it’s causes and a basic treatment plan to get your period back.
What is Hypothalamic Amenorrhea?
Hypothalamic Amenorrhea (HA) or Functional Hypothalamic Amenorrhea (FHA) is when a woman has no period for 6 months in a row or more, despite having no anatomical or disease-related reason for lack of menstruation. Functional means behaviour related and we will come to what those behaviours might be later in this post.
Primary vs. Secondary Amenorrhea
Amenorrhea is the medical term for missing periods or the absence of a menstrual cycle. Hypothalamic Amenorrhea and Functional Hypothalamic Amenorrhea are known as secondary amenorrhea. This is when a woman’s periods have stopped or she has missed several periods in a row. Primary amenorrhea is when a woman has reached reproductive age (usually15 or 16) and her periods have not yet started.
Primary amenorrhea can be due to genetic conditions affecting the ovaries, hormonal issues relating to the pituitary or hypothalamus glands or structural problems with the reproductive system. The most common causes of secondary amenorrhea are pregnancy, breast-feeding and menopause but it can also be due to birth control methods such as the contraceptive pill or implant as well as functional conditions such as Hypothalamic Amenorrhea.
Hypothalamic Amenorrhea symptoms
If you have ruled out other causes of missing periods, Hypothalamic Amenorrhea could be the most likely diagnosis. Aside from missing periods, there are many other symptoms which can occur with Hypothalamic Amenorrhea. I have listed some examples below, although not all (or even any!) of these symptoms have to be present and every woman’s body is different.
- Thinning hair or hair loss
- Feeling cold, especially cold hands and feet
- Excessive tiredness or low energy
- Anxiety and depression
- Low sex drive or no libido
- Abnormal appetite
- Low bone density or osteopenia
These symptoms are similar to those of hypothyroid. This is because Hypothalamic Amenorrhea often occurs alongside low thyroid function. Both are related to a lowered metabolic rate although the causes might be different. As a result, in some cases a hypothyroid diagnosis can be reversed following a Hypothalamic Amenorrhea treatment plan.
Hypothalamic Amenorrhea explained
If you aren’t interested in the science part then feel free to skip to the next section!
Hypothalamic refers to the hypothalamus, an area of the brain sometimes called the “master controller”. The hypothalamus has many functions, the main ones being regulating hormone levels and maintaining stable conditions inside the body. Primarily core body temperature, blood pressure and appetite. It does this sending out correcting signals responding to changes in internal and external factors.
One of these signals relevant to Hypothalamic Amenorrhea is the release of Gonadotropin-releasing hormone (GnRH). This signal causes another gland, the pituitary to release Follicle-stimulating hormone (FSH) and Luteinizing hormone (LH). FSH and LH are responsible for maturing a follicle in the ovaries and releasing the mature egg. The release of an egg is called ovulation and is the main event in the menstrual cycle.
Watch the short video below if you want to learn more about how the hypothalamus and pituitary glands work together.
The ovaries are the reproductive organs which release the sex-hormones estrogen and testosterone. These hormones also play a role in regulating the menstrual cycle and reproductive health. The hypothalamus and the pituitary are connected to the ovaries along what is called the Hypothalamic-Pituitary-Ovarian (HPO) axis. In Hypothalamic Amenorrhea, there is disruption to the HPO axis due to some sort of stress on the body. This results in low levels of FSH, LH and estrogen. Put simply, no ovulation and a missing period.
What causes Hypothalamic Amenorrhea?
There are several factors at play when it comes to missing periods:
- Under eating, chronic or restrictive dieting or poor nutrition
- Over-exercise, especially endurance sports
- Low body weight or rapid/extreme weight loss
- Stress and excessive worry
The typical woman suffering from Hypothalamic Amenorrhea is a type-A personality and over-achiever in all areas of life. Especially when this perfectionism extends to diet, exercise and body weight. Extreme examples are women who are constantly on a diet, restricting calories or types of foods and go running 7 days a week. Those who maintain a very low weight even though they are fighting against their body to stay there. Or women who work or study long hours expecting nothing but the best from themselves at all times.
But Hypothalamic Amenorrhea can also affect women in less extreme circumstances who might have lost weight quickly in a “healthy” way or who have been accidently under-fueling over a long period of time (I’m talking to you busy working mums!). Another example is women who have gone through a stressful life transition. Basically our bodies are trying to keep us safe and alive by conserving calories during a stressful time.
Treatment for Hypothalamic Amenorrhea
There has been a steady increase in the number of searches for “how to get my period back” over the last 10 years. In the case of Hypothalamic Amenorrhea recovery the formula is pretty simple although implementing it can be difficult!
EAT REST RELAX REPEAT
- Eat plenty of food and I’m talking a surplus of calories
- Let go of any diet restrictions and consume all food groups
- Take a break from intense exercise
- Rest or focus on low intensity movement such as light yoga
- Remove as many stressors from your life as possible
- Take time to relax and de-stress every day
- Consider therapy to help with making the changes above if they feel challenging
I will talk more about the specifics of this healing protocol in future posts. Alternatively, apply to work with me for personalised advice and guidance on your healing journey.
In conclusion, Hypothalamic Amenorrhea is a fairly common condition amongst women who restrict their diet, are under stress or exercise excessively. It is usually treatable and requires a combination of rehabilative nutrition, rest and stress management. This is best done under the guidance of a doctor, nutritionist or health coach depending on the severity of the situation.
I hope this article helped you to better understand Hypothalamic Amenorrhea and why your periods might have stopped. Let me know in the comments, what is the most difficult part of the recovery formula for you?
Over to you…
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Gibson S, Fleming N, Zuijdwijk C, Dumont T. Where Have the Periods Gone? The Evaluation and Management of Functional Hypothalamic Amenorrhea. J Clin Res Pediatr Endocrinol. 2020;12(Suppl 1):18-27. doi:10.4274/jcrpe.galenos.2019.2019.S0178