Hypothalamic amenorrhea

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, controls reproduction, and produces gonadotropin-releasing hormone (GnRH).

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Indicators of hypothalamic amenorrhea

Understanding how hormones impact fertility

Sometimes the hypothalamus stops producing GnRH, which reduces the amount of other hormones produced (FSH, LH, and estrogen). This causes ovulation and menstruation to stop, resulting in infertility.

  • GnRH: It 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.
  • FSH and LH: They signal the ovaries to produce estrogen.
  • Estrogen: It thins the cervical mucus and — along with progesterone (from LH) — prepares the uterus for a fertilized egg.

Diagnostic testing 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 for diagnosing ovulatory dysfunction, as well as one or more of the following tests:

  • Hormonal Studies: These blood tests measure the levels of 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.
  • 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.
  • 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, they 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 to trigger ovulation and menstruation again.

FAQs

Yes. Hypothalamic amenorrhea can lead to less estrogen production from the ovaries. Estrogen helps 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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