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Amenorrhea simply means the absence of menstruation (one or more missed menstrual periods), and it can be caused by a variety of things, including problems with the reproductive organs or hormones. Hypothalamic amenorrhea is amenorrhea due to a problem involving the hypothalamus, which is the portion of the brain that links the nervous system to the endocrine system via the pituitary gland.
What Happens in Hypothalamic Amenorrhea
The hypothalamus controls reproduction —it produces gonadotropin releasing hormone (GnRH). GnRH signals the production of other hormones needed for ovulation and after, such as follicle stimulating hormone (FSH) and lutenizing hormone (LH). FSH and LH signal the ovaries to produce estrogen, which thins the cervical mucus and, along with progesterone, prepares the uterus for a fertilized egg.
Causes of Hypothalamic Amenorrhea
Poor nutrition, stress and extreme exercise can alter signals to the brain because the brain is not getting adequate energy or nutrients to signal the reproductive hormones. Hypothalamic amenorrhea is often seen in women with eating disorders such as anorexia nervosa or women who are athletes or dancers and have very low body fat.
Women with hypothalamic amenorrhea may be:
- severely restricting their calories
- exercising more than two to three hours a day
- under severe stress
Diagnosing Hypothalamic Amenorrhea
A fertility doctor will need to rule out any other causes of amenorrhea, such as pregnancy or a problem with your pituitary gland. The doctor will complete a medical history and pelvic exam, as well as order blood tests to measure your levels of FSH, LH, estradiol, prolactin and human chorionic gonadotropin (HCG).
- Low levels of FSH, LH and estradiol may indicate hypothalamic amenorrhea.
- High levels of HCG indicate a pregnancy.
- High levels of prolactin suggest a tumor on the pituitary gland.
Your fertility doctor may also administer a progesterone challenge, which is test that will induce menstrual bleeding in women with some types of amenorrhea, but not in women who have hypothalamic amenorrhea. Women with hypothalamic amenorrhea do not have enough estrogen to thicken the uterine lining, so they will only bleed if given both estrogen and progesterone.
Treating Hypothalamic Amenorrhea
Lifestyle changes are the treatment for hypothalamic amenorrhea. Examine your lifestyle for extreme stress factors, extreme diet and extreme exercise. Reducing the amount of exercise and gaining weight, along with fertility drugs to help with ovulation and menstruation can help you on your way to starting a family.
It is also important for your long-term health to seek treatment for hypothalamic amenorrhea. Left untreated, a woman's risk for osteoporosis and heart disease increases.