Hypothalamic Amenorrhea

What is hypothalamic amenorrhea?

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.

What is amenorrhea?

Amenorrhea is when you don’t get your menstrual period. There are two main types of amenorrhea:

• Primary amenorrhea is when you haven’t gotten your first period by 16 or within five years of puberty.
• Secondary amenorrhea is when you’ve had regular periods, but you stop getting your period for more than three months. Hypothalamic amenorrhea is a type of secondary amenorrhea.

How common is hypothalamic amenorrhea?

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.

What causes hypothalamic amenorrhea?

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:

• Not eating enough food or restricting food.
• Poor nutrition.
• Excessive exercise.
• Emotional or psychological stress.
• Low body fat.
• Having an eating disorder such as anorexia nervosa.

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.

What are the symptoms of hypothalamic amenorrhea?

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:

• Depression and anxiety.
• Trouble sleeping.
• Low energy.
• Hunger.
• Vaginal dryness.
• Low sex drive.
• Hair loss.
• Headaches.

Can PCOS cause hypothalamic amenorrhea?

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.

How is hypothalamic amenorrhea diagnosed?

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:

• Blood tests to check levels of hormones that affect menstruation. These could include estrogen, prolactin, FSH and LH.
• Complete blood count.
• A pregnancy test.
• An MRI of your pituitary gland.

How do you treat hypothalamic amenorrhea?

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.

How long does treatment take?

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.

How can I prevent hypothalamic amenorrhea?

You can prevent hypothalamic amenorrhea by avoiding the common causes of the condition. This includes:

• Eating enough food for your activity level.
• Not restricting your caloric intake.
• Finding ways to reduce and manage your stress levels.
• Limiting extremely vigorous exercise.

How does this condition affect my body?

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:

• Being unable to get pregnant or having infertility.
• Decline in bone health, which can lead to osteoporosis.
• Higher risk of cardiovascular disease.
• Skin and hair problems such as hair loss and acne.

Can I get pregnant with hypothalamic amenorrhea?

It's unlikely that you'll get pregnant with this condition because disruptions in your menstrual cycle usually prevent ovulation. But sometimes ovulation still happens. And it can be hard to predict when your cycle will return to normal. Remember that you ovulate and can get pregnant before your menstrual bleeding returns the first time. It's a good idea to talk with your healthcare provider about birth control options if you're sexually active and don't wish to get pregnant.

What are the potential complications of hypothalamic amenorrhea?

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.

When should I see my healthcare provider?

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.