Hypothalamic amenorrhea is a condition in which menstruation stops for several months due to a problem involving the hypothalamus. The hypothalamus is in the center of the brain and controls reproduction. It produces 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 luteinizing hormone (LH) after ovulation. In turn, FSH and LH signal the ovaries to produce estrogen. Estrogen thins the cervical mucus and—along with progesterone (from LH)—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.
Medical Contribution: Stephen Greenhouse, M.D.
diagnostic tests for hypothalamic amenorrhea
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:
These blood tests measure the levels of following hormones: FSH, LH, human chorionic gonadotropin (hCG), and prolactin. Low levels of FSH and LH may indicate hypothalamic amenorrhea. High levels of prolactin may suggest a benign tumor on the pituitary gland, which can lead to amenorrhea. Human chorionic gonadotropin is a test used to confirm or eliminate the possibility of pregnancy.
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.
Magnetic Resonance Imaging (MRI)
A medical imaging technique that produces an image of the pituitary gland to detect a tumor or other abnormality.
treatment for hypothalamic amenorrhea
Treatment will vary depending on the cause. If your doctor suspects your daily routine is the cause of your amenorrhea, he or she may ask you 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.
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A friend told me that this disorder can increase my risk for osteoporosis and heart disease. Is that true?
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.
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