Hypothalamic amenorrhea is when your hypothalamus causes your period to stop. Common causes include excessive exercise, stress and undereating.
Hypothalamic amenorrhea (functional hypothalamic amenorrhea or FHA) is a condition where you don’t get your period (menstruate) because of a problem involving your hypothalamus. Your hypothalamus is the control center of your brain — it regulates many bodily responses such as your temperature, hunger and certain aspects of reproduction. Specifically, it releases gonadotropin-releasing hormone (GnRH), a hormone that works with follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estrogen to control menstruation.
Your hormones become unbalanced when your hypothalamus stops producing GnRH. This leads to irregular or absent periods.
Amenorrhea is when you don’t get your menstrual period. There are two main types of amenorrhea:
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Hypothalamic amenorrhea effects about 1.62 million women and people assigned female at birth (AFAB) between 18 and 44 in the United States and 17.4 million women and people AFAB worldwide.
Your hypothalamus is the command center for several bodily processes. It sends and receives messages, and signals other hormones to release chemicals into your bloodstream. When your hypothalamus gets a message that something is stressing your body, it can decide to go on strike (or stop working). That means it stops secreting GnRH, which is an important hormone for menstruation.
Reasons your hypothalamus may stop secreting hormones include:
Often, it’s a combination of all of these factors that lead to FHA (like exercising too much and not eating enough calories). This puts your hypothalamus in survival mode, putting certain bodily processes and functions on hold so it can focus on the most important ones (like breathing).
When it comes to your menstrual cycle, GnRH is responsible for triggering your body to create FSH and LH. These two hormones cause your ovary to release an egg (ovulation) during each menstrual cycle. Without sufficient levels of FSH and LH, ovulation and menstruation stop.
We often think of athletes or Olympians as having hypothalamic amenorrhea due to their activity levels, but it’s also common in teenagers and anyone experiencing stress from work or home.
The most common symptom of hypothalamic amenorrhea isn’t getting your period for three months or longer. The hormonal imbalance can cause other symptoms such as:
PCOS can cause a person to have irregular menstrual cycles or stop ovulating completely. However, it’s not a direct cause of hypothalamic amenorrhea. FHA is when your periods end due to a problem involving your hypothalamus.
Healthcare providers diagnose hypothalamic amenorrhea after ruling out other conditions that can cause you to stop menstruating. These could include thyroid or adrenal gland disorders or pregnancy.
Your provider will also ask for your medical history, perform a physical exam and pelvic exam and order several tests. These tests may include:
The main treatment healthcare providers use for hypothalamic amenorrhea is lifestyle changes. Lifestyle changes may include limiting vigorous exercise, gaining weight or finding ways to reduce stress levels.
Your provider may recommend speaking with a dietitian so you can better understand what nutrients your body needs and how many calories you should be eating each day. They can help you determine a healthy BMI (body mass index) and work with you on improving your diet to support your activity level.
Some people with hypothalamic amenorrhea see a mental health professional for cognitive behavior therapy. This is especially helpful for people who have eating disorders or who are in denial about the condition. Mental health professionals can also help with stress management techniques.
In some cases, your provider may recommend hormone treatment, birth control pills or fertility medication to induce menstruation.
It varies. Factors like your age, weight, activity level and genetics can play a role in how long it takes for your periods to come back. It most likely will take three to six months of consistent treatment to begin menstruating again.
You can prevent hypothalamic amenorrhea by avoiding the common causes of the condition. This includes:
Not having a menstrual period may seem harmless; however, it can cause both short-term and long-term problems. Some of the ways not getting a period affects your health include:
No. You can’t get pregnant unless you have a menstrual period. People with hypothalamic amenorrhea don’t get a period. Once your menstrual cycle returns, you can try to get pregnant.
Hypothalamic amenorrhea can lead to low estrogen levels. Estrogen is an important hormone in your body. One function of estrogen is to maintain healthy, strong bones. Without estrogen, women and people AFAB are at risk for osteoporosis and heart disease. Estrogen also helps with your mood. Lack of estrogen may lead to symptoms of depression and anxiety.
Contact a healthcare provider if you don’t have a period for three months. Even if you aren’t trying to conceive, not having a regular menstrual cycle could indicate other problems or lead to long-term complications.
A note from Cleveland Clinic
Hypothalamic amenorrhea could be a reason you aren’t getting your menstrual period. While it may seem like no big deal, not having a regular period can cause other health problems. If you haven’t had your period in three months or longer, talk to a healthcare provider. They can order tests to determine why you aren’t having a regular period and get you the treatment you need to begin menstruating again.
Last reviewed by a Cleveland Clinic medical professional on 11/10/2022.
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