Hypothalamic Amenorrhea: Causes, Treatment, Diagnosis

Hypothalamic amenorrhea is a medical condition in which there is cessation of menstruation cycle for many months due to a problem in the hypothalamus. The hypothalamus controls reproduction and is located in the center of the brain. The hypothalamus produces gonadotropin-releasing hormone (GnRH) which is responsible for producing other hormones that help in maturation of the egg and ovulation. These other hormones include follicle-stimulating hormone (FSH); and after ovulation luteinizing hormone (LH). These hormones then signal the ovaries to produce estrogen which along with progesterone prepares the uterus to receive a fertilized egg.

If there is any problem with hypothalamus, then it stops the production of GnRH, which in turn stops or cuts down the production of other hormones, such as FSH, estrogen, LH resulting in stopping of ovulation and menstruation leading to infertility.

Main causes of Hypothalamic Amenorrhea are stress, poor nutrition and extreme exercise. All these things can change the signals to the brain where the brain does not get sufficient nutrients or energy to trigger the production of other reproductive hormones. Hypothalamic amenorrhea commonly occurs in women who have eating disorders (anorexia nervosa) or women who have very low body fat, such as seen in athletes or dancers.

The characteristics of women with Hypothalamic Amenorrhea include:

• They are under severe stress.
• They are severely restricting their calorie intake.
• They are exercising and are engaged in intense physical activity for more than two to three hours every day.

• Consultation with a fertility specialist is required where he/she will exclude other causes of amenorrhea, such as problems with pituitary gland or pregnancy.
• A complete medical history and pelvic exam of the patient is done. Patient is asked questions of any recent diet or weight loss; how much is the patient’s BMI and if the patient is under some stress.
• Blood tests are done which measure the levels of FSH, estradiol, LH, human chorionic gonadotropin (HCG), and prolactin.
• If the levels of LH, FSH and estradiol are low, then it indicates hypothalamic amenorrhea.
• High levels of prolactin are an indication of a pituitary gland tumor.
• If the levels of HCG are high, then it indicates pregnancy.
• Ultrasound can be done to check the size of the ovaries, endometrial thickness and antral follicle count.
• A progesterone challenge test can be done in which menstrual bleeding is induced in women suffering from certain types of amenorrhea, but not hypothalamic amenorrhea. This is because women suffering from hypothalamic amenorrhea will not have sufficient estrogen to thicken the uterine lining. These women will bleed only if they are given both progesterone as well as estrogen.

The primary treatment for Hypothalamic Amenorrhea is making Lifestyle Changes. Women whose lifestyle consists of extreme diet, extreme stress and extreme exercise need to change all that. Hypothalamic Amenorrhea is treated by simply cutting the amount of exercise, reducing stress and gaining weight. These in combination with fertility drugs help with ovulation and menstruation along with paving the way for starting a family.

There are 2 important things for treating Hypothalamic Amenorrhea, and that is managing stress and gaining weight. Stress can be combated with meditation, sleeping, taking naps etc. Weight should be gained slowly by increasing your diet by adding more fruits and healthy fats, such as nuts and whole fat milk.

Hypothalamic Amenorrhea should not be ignored; as if it is left untreated then it greatly increases the risk of heart disease and osteoporosis in the patient.