Hypothalamic amenorrhoea – no periods due to weight, stress, exercise

Hypothalamic Amenorrhoea

Hypothalamic amenorrhoea is a condition whereby the part of your brain responsible for sending “go ahead and reproduce!” signals to the pituitary gland stops sending the message. The result of this interruption to your entire menstrual cycle is low libido, no periods, no ovulation, and no oestrogen. Essentially your hormone cascades stop cascading and you are left without important hormones that keep you feeling good and your body functioning as it was designed.

For more reasons why your period may have stopped, read our Secondary Amenorrhoea article. If you or someone you care for has never had a period, it can also be due to hypothalamic interruptions, since stress, disordered eating and overexercise can be present at any stage of our lives. In this case, it would be referred to as Primary Amenorrhoea, since the first period didn’t arrive.

It’s important to remember that hypothalamic amenorrhoea is the medical name for your periods stopping specifically due to the hormonal cascade being interrupted, and it isn’t a disease in and of itself. It refers to your periods stopping due to the hormones stopping – despite there being other reasons.

Functional hypothalamic amenorrhoea (FHA) is one of the most common causes of your periods stopping, with three main kinds: being too skinny, stress, and too much exercise. You might think, great! No periods! But having no periods is not the blissful holiday of your dreams – you need your hormones to keep your bones healthy, keep your libido happy, and to moisturise your vagina.

     Symptoms of hypothalamic amenorrhoea

  • Periods stop
  • Infertility
  • Low libido
  • Dry, irritated vagina
  • Low oestrogen signs
  • Low progesterone signs
  • Mood changes – irritability
  • Appetite changes
  • Insomnia
  • Feeling cold
  • Low thyroid function and associated symptoms

     How the hypothalamus regulates your fertility

The hypothalamus is the area of your brain responsible for controlling your fertility, due to the one important hormone it produces, GnRH.

Gonadotropin-releasing hormone (GnRH is the hormone that gets sent out into your body and brain that signals for the production of other hormones required both before and after ovulation: follicle stimulating hormone (FSH) and luteinizing hormone (LH) respectively. These two hormones in turn stimulate oestrogen production, which has impacts on the cervical mucous, and progesterone, which prepares the uterine lining for a fertilised egg.

Once the hypothalamus gives up on producing GnRH, all other hormones in turn stop being produced, bringing your menstrual cycle and fertility to a grinding halt.

     Diagnosing hypothalamic amenorrhoea

You will need to go through a process of elimination of other causes of stopped periods, including pregnancy or other health conditions. You will be examined and tested, ticking off each other problem as it is eliminated.

You will undergo hormone tests to measure FSH, LH, prolactin (for pituitary tumours), and human chorionic gonadotropin (hCG) (for pregnancy). You will have the progesterone challenge, which induces menstrual bleeding in some women after taking progesterone – if you have hypothalamic amenorrhoea, you will not bleed during this test. You may have your brain scanned to check for tumours or abnormalities.

The mixture of disordered eating, osteoporosis and no periods was first described in 1997, and was nicknamed the ‘female athlete triad’. If you follow a low-calorie low-fat diet and have a low body mass index (BMI), exercise a lot (and have low body fat), or are chronically stressed, you may have a more simple solution to your lack of periods.

     Treating hypothalamic amenorrhoea

Treatment will depend heavily on the cause. There may be simpler causes of lost periods like being underweight, so interventions may be prescribed to try to eliminate the simpler causes of your problems. Your doctor may prescribe hormones or medications, while other practitioners will work on stimulating your body to behave normally. Options here include herbal medicines, acupuncture, reflexology, lifestyle changes, diet adjustments, and others.

The goal of any treatments should be to correct the underlying imbalance, so we suggest starting with less invasive interventions with the help of a trained practitioner. Body fat is the first port of call – if you have less than 17 per cent body fat, your body can’t produce enough hormones to get your system going. If you overexercise, same thing, but with the addition of stress hormones. If you are stressed constantly, your stress hormones block the brain from sending out fertility signals.

Talk to your healthcare practitioner about what’s going on in your life – it might be hard to consider putting on weight or dropping down your exercise regime, but remember – your bone health and healthy hormones do way more for your wellbeing, libido, and happiness than you could ever imagine being fit or skinny would do. True story! If you are stressed, it’s time to get some strategies for life, because that level of stress is unsustainable.