Amenorrhea is the absence of menstruation, whether you miss one or multiple menstrual periods. Menstruation may fail to occur due to normal reasons- such as pregnancy or breast-feeding, or it may be a sign of a medical issue- like hypothalamic amenorrhea.
The hypothalamus is the portion of your brain that controls the pituitary gland and regulates hormones that start menstruation. In hypothalamic amenorrhea, the hypothalamus stops or slows production of gonadotropin releasing hormone (GnRH), which causes a reduction in follicle stimulating hormone (FSH) and luteinizing hormone (LH) that typical signal the ovaries to produce estrogen and mature eggs for release.
With lower than normal levels of FSH and LH, estrogen production and ovulation can stop- leading to amenorrhea and infertility.
Typically, hypothalamic amenorrhea is the result of lifestyle and physical causes. Poor nutrition, stress and extreme exercise can alter signals in your brain. It is most commonly found in women with eating disorders, athletes and dancers. You are at a greater risk of hypothalamic amenorrhea is you have one or more of the following:
Your fertility doctor will begin by examining all possible causes of amenorrhea, such as pregnancy, medication and thyroid issues. Blood tests will be used to measure your hormone levels. Another test your fertility doctor may recommend is a progesterone challenge. Administering progesterone will trigger menstruation in women with some forms of amenorrhea. For those suffering from hypothalamic amenorrhea, you will only begin to bleed when given both estrogen and progesterone.
If you are diagnosed with hypothalamic amenorrhea, your fertility doctor will likely recommend lifestyle changes. Finding mechanisms to reduce stress can help your body better regulate its hormone production. If you are underweight, you may need to gain in order to achieve a more healthy body weight. Your fertility doctor will also look to ensure you are receiving proper nutrition and maintaining a healthy exercise regimen- which may require you to increase calories and reduce workouts.
If you are trying to get pregnant, your fertility doctor can prescribe fertility drugs to induce ovulation and menstruation. Whether or not you are trying to get pregnant, it is important to address hypothalamic amenorrhea. When left untreated, it increases your risk of osteoporosis and heart disease.
