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Hypothalamic Amenorrhea

Hypothalamic amenorrhea is a condition in which menstruation stops for several months due to a problem involving the hypothalamus.

Hormones play a crucial role in every step of a successful pregnancy. The hypothalamus in the center of the brain controls reproduction. It produces the hormone, gonadotropin releasing hormone (GnRH). GnRH signals the production of other hormones needed for the egg to mature and for ovulation, such as follicle stimulating hormone (FSH) and after ovulation, progesterone luteinizing hormone (LH). In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and, along with progesterone, prepares the uterus for a fertilized egg.

Sometimes the hypothalamus stops producing GnRH, which in turn, will reduce the amount of other hormones produced (FSH, LH, and estrogen). Ovulation and menstruation stop, resulting in infertility.

How Hypothalamic Amenorrhea is Diagnosed

Diagnosing hypothalamic amenorrhea involves eliminating some of the other possibilities as to why your periods have stopped. For example, your doctor will want to make sure you're not pregnant or have another disorder that's causing the problem. Your medical history and a pelvic exam are necessary in diagnosing ovulatory dysfunction, as well as one or more of the following tests:

  • Hormonal studies - blood tests that measure the levels of the hormones, follicle stimulating hormone (FSH), luteinizing hormone (LH), human chorionic gonadotropin (HCG), and prolactin. Low levels of FSH and LH may indicate hypothalamic amenorrhea. High levels of prolactin suggest a tumor on the pituitary gland, which can lead to amenorrhea. HCG is a test used to confirm or eliminate the possibility of pregnancy
  • Progesterone challenge - a test that will induce menstrual bleeding (after taking progesterone) in women with certain types of amenorrhea, but not in women who have hypothalamic amenorrhea
  • Computerized Tomography (CT) - a 3-dimensional scan that produces an image of the pituitary gland to detect a tumor or other abnormality

Common Questions

Q What treatments are available to me?
A
Treatment will vary depending on the cause. If your doctor suspects your daily routine is the cause of your amenorrhea, you may be asked to make some changes, such as limiting your exercise or gaining weight. If this doesn't work, your doctor may prescribe hormone or fertility medications so that you will start ovulating and menstruating again.

Q A friend told me that this disorder can increase my risk for osteoporosis and heart disease. Is that true?
A
Yes. Hypothalamic amenorrhea can lead to less estrogen production from the ovaries. Estrogen helps to prevent bone loss, so if you lack estrogen you may be at increased risk for osteoporosis. Estrogen also helps to protect against heart disease. Your doctor may recommend estrogen therapy to reduce these risks if you do not wish to attempt pregnancy.

Ovulation Induction Medications may be recommended.

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