Hypothalamic amenorrhoea

Hypothalamic Amenorrhoea

Hypothalamic amenorrhoea is the long, complicated name for your periods stopping because of something going on in your brain.

The hypothalamus is responsible for releasing hormones, regulating body temperature, and other important tasks. It’s a small gland, but mighty.

Amenorrhoea is the medical name for the absence of menstrual periods. Thus, hypothalamic amenorrhoea refers to periods stopping due to something going on with the hypothalamus.

There are three main causes of hypothalamic amenorrhoea:

  • Not carrying enough body fat or having disordered eating
  • Stress
  • Too much exercise

The hypothalamus is the part of your brain that sends “go ahead and reproduce!” signals to the pituitary gland. When your period stops, the hypothalamus has stopped sending the message.

The delivery lady has gone on strike, pulled a sickie, or got hit by a bus. She’s out for the count.

The pituitary gland secretes hormones that get your reproductive motor running. If the signals from the hypothalamus to the pituitary gland stop, your hormone cascade grinds to a halt.

No hormones flowing means no ovulation, no fertility, no periods, no sex drive, no nothing. Your hormonal cascade stops cascading.

Symptoms of hypothalamic amenorrhoea

  • Absence of menstrual bleeding
  • Low sex drive
  • Dry, irritated vagina
  • Low oestrogen signs
  • Low progesterone signs
  • Mood changes – irritability, anxiety
  • Appetite changes
  • Insomnia
  • Feeling cold
  • Infertility
  • Low thyroid function and associated symptoms

Causes of hypothalamic amenorrhoea

  • Overexercising (causing low body fat, low body weight, high cortisol levels)
  • Extreme dieting (low or no-carb diets, calorie-restricted diets, low body fat, low body weight, causes high cortisol levels)
  • Stress and anxiety (high adrenaline and cortisol levels)

Why these result in no period

You may have noticed that each of the reasons for no period involve high cortisol levels.

Cortisol is one of your stress hormones, and while it’s not the only reason for your hormones to be interrupted, it is a major blockade to normal function of your hormone systems (and the rest of you).

High cortisol means you can run faster and fight a monster, but your body will start to degrade over time with chronic high cortisol levels.

When you have high cortisol levels, your body gets the message that you are in some way under stress, even if you feel ok in your head. The stress signals may be sent in many ways with cortisol levels being a major indicator.

Another signal may be caloric stress (not enough calories or carbs available, like during famine), or that you are physically extremely active (extreme circumstances).

Not having enough body fat to produce the hormones you need can also be a major interruption to a normal menstrual cycle. This is why skinny girls get their periods later than everyone else.

In your brain, the hypothalamus is the boss of your fertility because it produces one specific hormone that kicks off the rest of your hormones.

Without this one hormone – the delivery lady’s parcel of goodness, Gonadotropin-releasing hormone (GnRH) – the other hormones are just sitting around in your pituitary gland twiddling their thumbs. Nothing happens if nothing happens.

Diagnosing hypothalamic amenorrhoea

You will need to go through a process of elimination of other causes of a loss of periods, including pregnancy or other health conditions before a diagnosis can occur.

You will be examined and tested, in a process of elimination.

You are likely to undergo hormone tests to measure:

  • Follicle-stimulating hormone (FSH)
  • Luteinising hormone (LH)
  • Prolactin (for pituitary tumours)
  • Human chorionic gonadotropin (hCG) (for pregnancy)

You may undergo 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 the loss of 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 clearer answer to your lack of periods.

Treating hypothalamic amenorrhoea

You might think it’s fun or convenient to skip your periods for a while, but a regular period is a sign of health. When your periods stop or become irregular, it means something is up and needs your attention.

Don’t ignore the messages your body is sending you.

Treatment will depend heavily on the cause. There may be obvious causes of lost periods like being underweight, so interventions may be prescribed to try to eliminate these first.

Depending on which type of practitioner you seek out to help once you have been diagnosed, you may receive the following advice:

  • Increase your body fat (you need fat to make hormones)
  • Increase your intake of calories and possibly carbohydrates (you need calories and carbs to ease stress hormone production)
  • Do less exercise or less vigorous exercise
  • You may be prescribed herbal medicines or supplements to help boost your nutrient levels – using your body’s resources up can leave you deficient
  • You may be prescribed hormones or medications by a doctor
  • You may like to try acupuncture, reflexology, lifestyle changes, diet adjustments, among other treatments to help stimulate your body to relax and repair
  • Don’t underestimate the importance of your emotional wellbeing here – get support
  • Get counselling for disordered eating/body dysmorphia – if you are over-exercising, under-eating/disordered eating, you may have a few demons to conquer – do it!

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, while also blocking many processes in your body that you need, like immunity.

Typically the thyroid is one of the first things to go. 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 that your bone health and healthy hormones do way more for your wellbeing, libido, and happiness than you could ever imagine being super fit or skinny would do. True story!

If you are stressed, it’s time to get some new strategies, because a high level of stress is unsustainable.

Why no period isn’t a disease by itself

It’s important to remember that hypothalamic amenorrhoea is the medical name for your periods stopping specifically due to the hormonal cascade in the brain being interrupted.

Hypothalamic amenorrhoea is not a disease in and of itself, but a symptom.

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 into your body and brain that signals for the production of other hormones required both before and after ovulation: follicle-stimulating hormone (FSH) and luteinising hormone (LH) respectively. (Which is why they are part of the testing regime.)

These two hormones, in turn, stimulate oestrogen production, which has impacts on 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.

Understanding the terms we use when you have lost – or never had – your period

The classifications matter because the cause can be narrowed down a little easier if you know whether periods used to be normal and then something changed, or, if they were never normal. This is an important clue.

Primary = from the beginning, first
Secondary = appeared later, second

(From Greek)
a – negative
men – month
rhoia – flow

Never had a period (primary amenorrhoea)

If you have never had a period, it is known as primary amenorrhoea, because the interruption to a normal menstrual cycle was there from birth or puberty. 

Hypothalamic amenorrhoea can fit into the primary amenorrhoea category for the same reasons as it fits into the secondary classification: stress, disordered eating, and over-exercising.

Young girls are more stressed than ever, and interruptions to brain chemistry and hormone systems can occur around the time periods would normally be starting.

Period stopped (secondary amenorrhoea)

When your period stops after being regular or at least present (but maybe irregular), it is medically known as secondary amenorrhoea.

Not getting a period for a while or skipping periods means something has changed, and the cause of that change needs to be investigated. Something is going awry.

Find more options for cause of periods stopping on the secondary amenorrhoea page

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Josephine Cabrall BHSc(NAT) | ATMS
Josephine Cabrall is qualified naturopath specialising in PCOS and hormonal and fertility issues, based out of Melbourne, Australia. Josephine is a fully insured member of the Australian Traditional Medicine Society (ATMS).