Hypothalamic Amenorrhea
Have your periods suddenly stopped?
If you have recently increased your exercise, are experiencing excessive stress, or seriously restricting your food intake and are experiencing absent periods.
You may have HA.
What is Hypothalamic Amenorrhea?
Functional Hypothalamic amenorrhea occurs when the hypothalamic-pituitary-ovarian (HPO) axis is suppressed due to an energy deficit stemming from
stress
weight loss (independent of original weight)
excessive exercise
or disordered eating.
As a result of this, a woman’s menstrual cycle can come to a halt. This is called secondary amenorrhea.
Secondary Amenorrhea - the cessation of regular menses for three months or the cessation of irregular menses for six months. In other words, a woman who usually has periods, stops having her period.
What is Primary Amenorrhea - failure to ever have a menstrual cycle. In other words, a woman who has never had a period.
According to the American Society of Reproductive Medicine, FHA is responsible for 20–35 % of secondary amenorrhea cases. The incidence is higher in athlete women - so those of you training for your Iron Man and Triathlon Challenges listen up!
It is estimated that approximately 50 % of women who exercise regularly experience subtle menstrual disorders and approximately 30 % of women have amenorrhea (no periods). The complex combination of distorted eating, amenorrhea and osteoporosis (brittle bones) was first described in 1997 and is known as Female Athlete Triad. Patients with functional amenorrhea may demonstrate the features of the female athlete triad, which consists of
insufficient caloric intake with or without an eating disorder
amenorrhea (absent periods) - The American College of Obstetricians and Gynecologists (ACOG) have reported the prevalence of absent periods in elite runners is as high as 65% compared to 2-5% in the general public
low bone density or osteoporosis. ACOG also found that deterioration in bone density was found in 22-50% of elite female athletes compared to 12% on the general public.
Why is this important?
Natural ovulatory menstrual cycles are how we make estrogen and progesterone which are important for general health, not just for making a baby. Regular menstrual cycles with consistently normal ovulation during the premenopausal years have been shown to prevent osteoporosis, breast cancer and heart disease. We benefit from the hormones naturally produced as a result of ovulation and so if this is switched off as a result off HA, then we will feel the consequences. Functional hypothalamic amenorrhea is related to profound impairment of reproductive functions including anovulation (no ovulation) and infertility and so having absent periods is a serious sign that something is not quite right. Women’s health in this disorder is disturbed in several aspects including the skeletal system, cardiovascular system, and mental problems. Patients manifest a decrease in bone mass density, which is related to an increase in fracture risk. Therefore, osteopenia and osteoporosis are the main long-term complications of FHA. Cardiovascular complications include endothelial dysfunction and abnormal changes in the lipid profile (such as cholesterol and triglycerides) as well as a higher risk of endometrial cancer (ACOG).
How is it treated?
Treatment of functional hypothalamic amenorrhea involves nutritional rehabilitation (increase in calorie intake) as well as reductions in stress and exercise levels. A woman’s menstrual cycle typically returns after correction of the underlying nutritional deficit, however this has been known to take time, sometimes taking years. Bone loss is best treated by reversal of the underlying process just mentioned, and the the woman should undergo bone density evaluation and also take calcium and vitamin D supplements. Although the bone loss is partly secondary to estrogen deficiency, estrogen replacement without nutritional rehabilitation does not reverse the bone loss. Combined oral contraceptives will restore the menstrual cycle, but will not correct bone density. Leptin administration has been reported to restore pulsatility of gonadotropin-releasing hormone and ovulation in these patients, but its effect on bone health is unknown.
Listen up Ladies!
Absent periods should not be ignored. Ovulation and menstruation are important for hormone production and for maintaining reproductive function. Functional hypothalamic amenorrhea is related to profound impairment of reproductive functions including anovulation (no ovulation) and infertility and so having absent periods is a serious sign that something is not quite right.
Ignoring the signs can often result in a long recovery time. Often years.
Ladies, please see your Gynecologist if your periods have stopped - it may only be a matter on increasing calorific intake and reducing stress and exercise in order to regulate them again. Noticing these changes and speaking up will safeguard your future fertility, slow down bone loss and reduce levels of anxiety.