What is amenorrhea?
Amenorrhea is the absence of menstrual periods. There are two types of amenorrhea: primary and secondary. Primary amenorrhea (PA) is the absence of periods by the age of 16. Secondary amenorrhea (SA) is a condition whereby a woman misses her period for 3 and more consecutive months. Hypothalamic amenorrhea is the most common cause of secondary amenorrhea.
Studies show that approximately 50% of women who exercise on a regular basis experience abnormal menstrual cycles and about 30% have amenorrhea.
What is hypothalamic amenorrhea?
Hypothalamic amenorrhea also referred to as hypothalamic hypogonadism is a condition whereby a woman does not get her menses due to an abnormality of the pulsatile release of the gonadotropin-releasing hormone (GnRH).
This abnormality is attributed to poor diet, chronic stress, or too much exercise. If you have hypothalamic amenorrhea, it means that you are not getting enough calories in your body, which is why it is common in women who are anorexic.
It may also mean that you are exercising too much or you are under too much stress. In fact, studies indicate that hypothalamic amenorrhea is common in dancers and performance athletes.
What causes hypothalamic amenorrhea?
The following are some common causes of hypothalamic amenorrhea.
Natural causes
Physiologic causes of hypothalamic amenorrhea are pregnancy, breastfeeding, and menopause.
Hormonal disturbances
Hormonal disturbances are common in women who are under a lot of stress. If you have stress-related hypothalamic amenorrhea, it means that there is a hormonal imbalance.
The condition develops when there is an increased secretion of the corticotropin-releasing hormone, and the adrenocorticotropin hormone from the pituitary gland, resulting in the reduction of the GnRH secretion.
Other studies show that there is a link between hypothalamic amenorrhea and the serum growth hormone. Researchers have found that when the serum growth hormone increases especially at nighttime, this can increase your chances of developing hypothalamic amenorrhea.
Other clinical studies indicate that a GnRH-related abnormality can be due to hypoestrogenism, a condition characterized by low levels of estrogen. When a woman is deficient of estrogen, she may experience symptoms such as abnormal or absent periods, hot flashes, mood swings, insomnia, depression, and even painful sex.
Diet
Poor diet is one of the common causes of hypothalamic amenorrhea. Some women have eating disorders that may be difficult to overcome. Anorexic women, for example, are at higher risk of developing hypothalamic amenorrhea than healthy women.
This is due to the fact that anorexic women have poor eating habits. They deny themselves food because they don’t want to gain weight or because they have image-related self-esteem issues.
Of course, there are other reasons why anorexic women avoid eating or eat very little. But the fact is that eating disorders can cause hypothalamic amenorrhea and other health complications.
Secondary amenorrhea is especially common in anorexia sufferers. If an anorexic goes without treatment, they may develop a variety of complications including infertility.
On the other hand, some women in an attempt to maintain a healthy lifestyle may develop hypothalamic amenorrhea if their regimen goes awry. It is not uncommon to find women sticking to a particular diet because they want to maintain a particular weight.
Unfortunately, this may turn into an obsession where you find the person sticking to a specific diet, which over time may prove to be harmful.
In short, unless the person accepts that they have a problem, it becomes difficult to treat diet-related hypothalamus amenorrhea and other complications related to eating disorders. That is why management should be multidisciplinary including medical, dietary and mental health support.
Exercise
There is nothing wrong with exercising on a regular basis to keep fit or to maintain your figure. But when exercising becomes an obsession, this is a problem.
It is common to find women athletes exercising and training a couple of hours a day, which is why hypothalamus amenorrhea is common in performance athletes, skaters, and dancers.
Studies show that women athletes who weigh about 49 kilograms and lose about 4 kilograms when they exercise are most likely to develop hypothalamic amenorrhea. This is because they have less fat than non-athletic women. According to researchers a change in body fat can lead to menstrual disorders.
Excessive exercise also lowers the leptin levels in the body. leptin is a hormone that regulates the energy balance by curbing hunger. However, a reduction in body fat and increased levels of negative energy balance lowers leptin levels. As a result, the GnRH levels decrease leading to hypothalamic amenorrhea.
Contraceptives
Some birth control pills are known to interfere with the normal menstrual cycle. Other contraceptives known to cause hypothalamic amenorrhea include implants such as intrauterine devices and injectable contraceptives. It may take a few months for menstrual periods to become normal again.
Medical problems
Certain diseases or illnesses can cause hypothalamic amenorrhea. Some of these illnesses include:
- Polycystic ovary syndrome (PCOS) – This is a hormonal-related disorder that affects girls and women of reproductive age. Women with this condition tend to produce more male hormones (such as testosterone). This change in hormone levels causes menstrual irregularities, acne, obesity, and excess hair growth. The ultrasound feature of PCOS is bog number of pearl-sized follicles (small fluid-filled sacks) on one or both ovaries.
- Thyroid disorders - hyperthyroidism or hypothyroidism can cause amenorrhea and other menstrual irregularities.
- Pituitary adenoma – this is a condition in which non-cancerous tumors grow in the pituitary glands. These tumors can affect the hormone responsible for regulating your periods. The most common pituitary adenoma is called prolactinoma, it produces prolactin – a hormone responsible for breastfeeding.
Symptoms of hypothalamic amenorrhea
Some common symptoms associated with hypothalamic amenorrhea depending on its cause include:
- Absent menses
- Low libido
- Difficulty sleeping
- Depression
- Low energy
- Increase hunger
- Anxiety
- Acne
- Nipple discharge and blurry vision
Diagnosing hypothalamic amenorrhea
Hypothalamic amenorrhea is a ‘diagnosis of exclusion’ which means that your health care provider should first rule out all other conditions that interfere with normal menstrual periods such as pregnancy, thyroid and pituitary problems To do this, your doctor may, first of all, perform a physical exam including pelvic examination and ultrasound, order a pregnancy test, full blood count, hormonal blood test (thyroid hormones, estrogen, androgens, prolactin) brain CT or MRI.
To confirm a hypothalamic amenorrhea your doctor may need to perform a GnRH stimulation test to check for hypothalamic amenorrhea. This is the most reliable test to check for this condition.
Your doctor may also perform a chromosome evaluation to check for abnormalities. There are cases whereby hypothalamic amenorrhea is attributed to chromosomal abnormalities.
Treatment for hypothalamic amenorrhea
Hypothalamic amenorrhea is reversible with treatment. Some treatment options require a change in diet especially if you are suffering from diet-related hypothalamic amenorrhea. If you eat too little food every day, your doctor may recommend increasing your calorie intake by eating more food.
If you are anorexic and you have hypothalamic amenorrhea, your doctor may prescribe medications, diet change and mental health support which is necessary in this condition.
If you are suffering from stress-related hypothalamic amenorrhea, your doctor may recommend therapies to help you manage stressful situations that increase your stress levels such as yoga and meditation.
Hypothalamic amenorrhea which is a result of estrogen deficiency is often treated using hormonal replacement therapy. Women who have low levels of estrogen, as well as hypothalamic amenorrhea, are at higher risk of low bone density.
With the hormonal replacement therapy, this can help prevent bone loss. Your doctor may also add calcium and vitamin D supplements to the treatment regimen to help prevent further loss of bone density.
Lastly, it is important that women who have hypothalamic amenorrhea get support and counseling especially in cases where the condition is related to stress or eating disorders. This is because there are also mental and emotional problems that need to be addressed.
Women who are constantly stressed out may also suffer from depression, chronic anxiety, irritability, and insomnia. And therefore require a great deal of counseling and support.
The same goes for women who have eating disorders. Women who are underweight or an anorexic suffer from self-esteem issues. It is a mind thing, which when coupled with negative emotions can affect the normal functioning of the body.
Timeline
If you are on birth control pills, you may go a month or more without your periods. However, this only happens when you take certain birth control pills that help extend the time length of your next period.
However, if you are on the pill to help prevent unintended pregnancy but not to lengthen the time until your next period and suddenly you miss your menses, consult your doctor.
Some women tend to think its normal, but if you miss your menses for three and more consecutive months, this is a sign that you have secondary amenorrhea and you need to go for a check-up to determine the cause.
Once you are diagnosed with amenorrhea and your doctor has determined the cause, he will recommend a treatment option that best suits your situation.
So if the condition is because you are under constant stress or you have an eating disorder, you can rectify the problem by changing your diet and by finding ways to distress. Depending on your effort and commitment, you may recover quickly.
If the problem is medically related, your doctor may recommend medication and other therapies to help treat the underlying cause. The recovery period may depend on the root cause and its severity.
Diet
No matter the disease or illness you may be suffering from, doctors always recommend eating a healthy balanced diet. A good diet can help alleviate the symptoms associated with hypothalamic amenorrhea. It may even be the best course of treatment for the condition.
However, it is also important that you manage your weight. Studies show that there is a strong link between hypothalamic amenorrhea and obesity.
