The Basics of Hypothalamic Amenorrhea (HA)

Gang, real talk time. Your periods are your fifth vital sign, and a fantastic indicator of your overall health. No, really. Which means that any changes to your cycle or periods shouldn’t be ignored. But what if they stop altogether? If you’re not pregnant, that could be down to something known as Hypothalamic Amenorrhea. And that can have serious consequences for your wellbeing. Here’s everything you need to know.

Wait. Periods can just stop?

In a word, yes. Pregnancy aside, the hormonal balance that keeps your menstrual cycle ticking over is incredibly delicate and easily distracted. Generally speaking, absence of periods, or Amenorrhea, is defined as no periods at all for three months or more. And any number of things can disrupt your cycle, Oh yes, an absence of periods can mean your entire cycle has been disrupted and the lack of bleeding may be your first clue.

In general, amenorrhea can be caused by a number of conditions including PCOS and Thyroid issues, as well as Menopause. But it can also stem from an issue with your H-P-O axis. For those who don’t speak science, that’s the hormone loop that goes from your Hypothalamus to your Pituitary gland and on to your Ovaries and back again. It’s this trio of glands that is responsible in large part for your entire menstrual cycle.

And as you may have guessed, it’s a feedback loop that is incredibly sensitive, as anyone who has ever experienced periods will attest. Lack of sleep, changes in diet, even changes in your routine can have a knock-on effect on your cycle. There is, though, a form of Amenorrhea that stems from a Hypothalamus gland that has, for all intents and purposes, stopped talking to your reproductive system.

HA, or Hypothalamic Amenorrhea, to give it its full title, is way more common than any of us knew. In fact, over 17 million women across the globe are currently living with it. So we thought it was about time we got educated, gang.

How does Hypothalamic Amenorrhea work?

Well, your Hypothalamus is basically the commander-in-chief of your Endocrine System, the hormone superhighway of your body. Which means it’s involved in almost every process you can think of, and that includes reproduction.

Here’s how that breaks down. During the first half of your cycle, your Hypothalamus produces a hormone, known as GnRH, that tells your pituitary to start increasing Follicle-Stimulating Hormone, or FSH production. The rise in FSH tells your Ovaries to kickstart the growth of multiple eggs, all the while producing increasing the amount of Estrogen they produce.

Once FSH and Estrogen levels reach a peak, Luteinizing Hormone, or LH, is released, letting your Ovaries know it’s time to release your dominant egg. That leads to Ovulation, and a drop in LH, FSH, and Estrogen, while Progesterone increases. That rise helps your uterus prepare to house a fertilized egg. If fertilization didn’t happen, then Progesterone drops, leading to PMS and your period.

At which point, your Hypothalamus kickstarts the process once more and a new cycle begins. But if your Hypothalamus produces too much or too little of that kickstarting hormone, then your entire cycle comes to a halt. No kickstarting GnRH means no FSH. If there’s no FSH,  then there’s no Estrogen and no LH. All of which means no Ovulation, no peak Progesterone, and eventually, Hypothalamic Amenorrhea.

What are the symptoms or effects of HA?

Hypothalamic Amenorrhea is the very definition of a hormone imbalance, except that with it, you get several for the price of one. It tends to affect women between around 18 and 44, generally well before Menopause, and while some have no symptoms outside of an absence of periods, others find the physical and emotional effects can be far-reaching.

Low Progesterone can cause sleep disturbance, temperature changes, weight fluctuations, and digestive issues as well as depression, mood swings, and anxiety.

Low Estrogen can put you through a kind of pseudo-Menopause, leaving you with brain fog, headaches, muscle and joint pain, mood swings, hair loss, dry skin, low concentration, and productivity. It can also increase your risk of bone density loss, heart disease, and type 2 Diabetes.

Low FSH and LH, alongside low Estrogen can have a huge impact on your fertility, making conception incredibly difficult.

Of course, as with all hormone-related issues, signs, effects, and symptoms may be entirely individual. So you might see some, none, or all of the above. And as you might imagine, that can make diagnosis very hard.

What causes HA?

Ah. This is one of those harder-to-answer questions. As we mentioned, hormone balance can be upset by any number of things, and emotional stress is a big component of HA. And while that might sound strange, your mental health can have a significant impact on your physical wellbeing, thanks to your hormones.

Increased levels of the stress hormone Cortisol can affect how well your Hypothalamus is working. And that can include suppressed LH,  which can, in turn, lead to HA.

Extreme levels of exercise can also be a factor, particularly if you’ve lost a lot of body fat. Burning huge amounts of energy while working out is amazing, but if you’re not putting an equal amount back into your body via food, there might be an issue. Burning more calories than you eat is a great way to lose weight, but if you keep going, then you end up in an energy deficit.

Your body needs a certain amount of energy to maintain all of its functions as well as make hormones. But if it doesn’t get enough energy to do everything, it can enter survival mode. And that means shutting down any processes not directly involved in keeping you alive, including reproduction. Then there’s the matter of fats.

To ensure proper function, your body needs a certain amount of fat. Whether the stored or eaten kind, some fat is necessary, and completely ridding yourself of it can have a similar effect. Unbalanced nutrition can have a massive impact on your hormones.

Hypothalamic Amenorrhea and eating

Time for some more real talk, gang. Hypothalamic Amenorrhea is often associated with disordered eating. But we want to be clear that an HA diagnosis doesn’t mean you’re also living with Anorexia, and vice versa. Admittedly, the theory used to be that HA and Anorexia went hand-in-hand. But that’s 20th-century thinking. These days, we know better, and here’s why.

Everyone is different. And yes, we know we say that literally every day, but HA is one of the reasons we’ll keep saying it. That’s because the weight at which your body will shut down your menstrual cycle is entirely individual. It’s based on the minimum weight and energy consumption necessary for the optimal function of your body and no one else’s.

Which means your periods may stop at a lighter or heavier weight than the woman standing next to you. What’s concerning is that even a 10lb weight loss can increase your risk of HA, regardless of when you lost that weight. The key seems to be that you lost it all at once, and hormones appear to have a great memory.

Getting an HA Diagnosis

It won’t surprise you to learn that there’s no test for HA. In fact, the only way to get a diagnosis of Hypothalamic Amenorrhea is when all other conditions have been ruled out. And, as you may have noticed, the signs and effects of HA could be mistaken for many other hormone-related issues.

And that essentially means you’ll go through a battery of tests and exams looking for literally everything else before HA is confirmed. That’s just how these things are done, right?

Treatment for Hypothalamic Amenorrhea

So, let’s start with the less good news. There is no cure for HA. Now that’s out of the way, here’s the very good news: Hypothalamic Amenorrhea is, in the majority of cases, temporary. Admittedly, that doesn’t make living with it any easier, but at least there’s the hope of a return to periods.

Some slightly less good news: Treatments are, um, sparse. For the most part, they’re concerned with gently encouraging your Hypothalamus to start talking again. And that generally involves some deceptively simple things.

Reducing stress

Yes, we know. This sounds obvious and amazing, but it’s often way harder than anyone will ever admit to. Breathwork, getting outside for a few minutes, sleeping more, losing yourself in a book or podcast, or lounging in the tub are all excellent stress relievers. Find what works for you and give yourself a break every now and then.

Talking

As you probably already know, we’re big believers in the power of saying things out loud. Talking to a friend, a relative, or a therapist can make a massive difference to your mood, make you feel less isolated, and even lower Cortisol levels.

Food

Slowly increasing calorie and fat intake to the right levels for you, with the help of a nutritionist, can improve and support your natural cycle. Some women see a return of their periods in around six months.

Exercise

Staying fit is, of course, important, but balance is key. Which means ensuring you’re not burning more calories during a workout than you’re eating during the day. Choose low to medium-intensity exercise, as well as Yoga, Tai Chi, or Pilates to strengthen your bones and muscles and center your thoughts.

HA and hormone therapy

Now, we get that this might sound odd. If you’ve got lower hormones, replacing them is a great idea, right? Well, it’s not quite that simple. Admittedly, extra Estrogen, in the form of Hormone replacement therapy can improve fertility and reduce some symptoms, but can be a temporary solution. And birth control is a definite no-no.

Why? Well, although you will get regular bleeding while you’re using it, that won’t be a period. Hormonal birth control actually stops your natural cycle, and the bleeding is caused by withdrawal from the hormones. So you’ll have no idea if your periods have returned until you’ve stopped taking it.

Hypothalamic Amenorrhea: Do I have it?

Gang, if you recognize anything we’ve talked about, please, and we cannot stress this enough, please consider talking to a healthcare professional. They can help you rule out any underlying hormonal causes for stopped periods and any symptoms you might be seeing. If nothing else, they can put your mind at rest and support you on your journey to a diagnosis.

And that goes double if you think you might be living with disordered eating. Dietary restrictions of any kind can seriously impact your health and emotional wellbeing, because nutrition is closely linked to hormone health and everyone is different. Nutritionists, therapists, and doctors can advise and guide you toward nutrition and lifestyle changes that’ll support your hormones and your wellbeing.

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