Understanding Hypothalamic Amenorrhea (June 2023)
When I was growing up, my mother used to talk about “when you get your period…” and share how this was reflective of becoming a woman and why it’s important for the development of bone density. I feel fortunate that I grew up understanding the reasons menstruation is important.
However, many of my clients who are at an age where they started their menses, then lost it (or have never received it despite being old enough) seem relieved to not have to “deal” with the inconveniences of it—until their physician explains the problems that can develop over time from not menstruating. This article will explain what hypothalamic amenorrhea is, how it can develop and what needs to be done to resolve it.
Amenorrhea is a clinical term meaning “not having a menstrual cycle.” There are two types of amenorrhea: primary and secondary. Primary amenorrhea happens when menses has not started by age 15, and is usually caused by anatomical abnormalities, or by chromosomal irregularities that lead to what’s known as primary ovarian insufficiency.
Secondary amenorrhea is when a female has had at least one menstrual period, then loses it for several months for reasons other than pregnancy. Polycystic ovary syndrome (PCOS) is one major cause of secondary amenorrhea. Another is hypothalamic amenorrhea, which is caused by a problem with a part of the brain called the hypothalamus.
The hypothalamus regulates the automatic nervous system, which is the part of the nervous system that helps the body regulate body temperature, hunger, thirst, sleep and emotions. The hypothalamus also plays a role in reproduction by producing a hormone called gonadotropin releasing hormone (GnRH), which tells the female body to menstruate, unless they are pregnant.
When a female has hypothalamic amenorrhea, the hypothalamus will either stop producing GnRH, or fail to produce enough, resulting in loss of menstruation. This is a concern because hypothalamic amenorrhea can contribute to several medical problems, including bone loss (which can lead to osteopenia and eventually osteoporosis) and infertility.
Hypothalamic amenorrhea can happen because a female is restricting or not eating enough food, exercising excessively, and has low body weight or body fat levels, possibly due to having anorexia nervosa. Experiencing significant emotional or psychological stress can also affect the hypothalamus. Female athletes who have a low BMI and a lower body fat percentage are at higher risk of developing hypothalamic amenorrhea.
The good news is that by making adjustments to your diet and activity, menstruation can return. Working with a registered dietitian nutritionist is one way to help improve the regularity of your menstrual cycle by helping you develop the best possible relationship with food and your body.
Nawaz G, Rogol AD. Amenorrhea. Treasure Island, FL: StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK482168/
Shufelt CL, Torbati T, Dutra E. Hypothalamic amenorrhea and the long-term health consequences. Semin Reprod Med. 2017;35(3):256-262.
What causes amenorrhea? Eunice Kennedy Shriver National Institute of Child Health and Human Development website. https://www.nichd.nih.gov/health/topics/amenorrhea/conditioninfo/causes. Updated January 31, 2017
Rinaldi, Nicola No Period. Now What, 2016