Hypothalamic (Secondary) Amenorrhea

Home » Diagnosing Infertility » Hypothalamic Amenorrhea

Secondary amenorrhea is when a woman who previously menstruated on a regular basis misses her periods for six months, or when a woman who previously experienced irregular periods skips her periods for 12 months. The most common form of secondary amenorrhea is hypothalamic amenorrhea, where the female body reverts to survival mode because it cannot sustain reproductive mode.

Hypothalamic amenorrhea develops when poor nutrition or stress alters your signaling to the brain to regulate the menstrual cycle. Women with this condition may be severely restricting their caloric intake, exercising more than two to three hours a day, or under major psychological stress. It is a common pattern seen in performance athletes and dancers as well as women with anorexia nervosa, with the common denominator of very low body fat levels and significantly low body mass index (BMI). In this situation your brain doesn’t get adequate energy or macronutrients to pulse the hormones that govern follicle ripening and release of eggs.

How Is Hypothalamic Amenorrhea Diagnosed?

To diagnose hypothalamic amenorrhea, Dr. Zoneraich first tries to eliminate some of the basic possibilities of why your periods have stopped. He checks to ensure that you are not pregnant or that you do not have a pituitary problem that’s causing menstruation to stop. He will typically order the following blood tests:

• Hormonal Blood Tests – to measure the levels of your key hormones, including FSH (follicle stimulating hormone), LH (luteinizing hormone), E2 (estradiol), HCG (human chorionic gonadotropin) and prolactin. High levels of HCG indicate a pregnancy. Low levels of FSH, LH and E2 may indicate hypothalamic amenorrhea. High levels of prolactin suggest a tumor on the pituitary gland.
• Progesterone Challenge – a test that will induce menstrual bleeding in women with some types of amenorrhea, but not in women who have hypothalamic amenorrhea. In general, these women do not have enough estrogen to thicken the uterine lining, and therefore will only bleed if given both estrogen and progesterone, as in the form of a birth control pill.

Can Hypothalamic Amenorrhea Be Treated?

Reversing hypothalamic amenorrhea is possible by examining your lifestyle for unusual stress factors, including extreme diet and exercise habits. These lifestyle changes can be done in conjunction with fertility medications to help you to start ovulating and menstruating again.

What Happens if Hypothalamic Amenorrhea Is Not Treated?

Untreated, hypothalamic amenorrhea can lead to continued problems with infertility as well as osteoporosis and heart disease. If you feel that you have hypothalamic amenorrhea and do not wish to become pregnant, it is still important to seek out medical treatment for your condition.

Next page: Male Factor >>