Did you know that your brain — specifically, the hypothalamus — can impact your period? It’s a lesser-known condition called hypothalamic amenorrhea and is when a person does not menstruate due to an imbalance in the brain’s control center. 

In fact, this condition impacts 1.62 million women in the United States and 17.4 million globally. 

Primary vs. secondary amenorrhea

Primary amenorrhea is when someone does not start their period by the age of 16 years old. This means they have never had a period at all. 

The cause of primary amenorrhea may be a chromosomal or genetic abnormality that prevents the ovaries from functioning normally. Some people may have a condition known as Turner syndrome, which is when someone is missing — either partially or totally — an X chromosome. The syndrome can cause infertility, heart problems, and alter someone’s appearance. This syndrome may contribute to the cause of a missing period. 

Secondary amenorrhea is when a period is missing for at least three months or more. Other symptoms include depression, insomnia, fatigue, immense hunger, vaginal dryness, low sex drive, hair loss, and headaches. 

Not having a period can cause short and long-term issues like not being able to get pregnant, a decline in bone health, higher risk of cardiovascular disease, depression, anxiety, hair loss, and acne. 

Secondary amenorrhea can be caused by pregnancy, menopause, certain birth controls like an IUD, medications, chemotherapy, polycystic ovary syndrome, thyroid problems, or pituitary tumors. 

According to a study published in Mayo Clinic Proceedings, one-third of secondary amenorrhea patients have hypothalamic amenorrhea. Let’s dive into the condition and how it can impact someone’s life. 

How is the hypothalamus related to menstruation? 

Your hypothalamus is the control center of the brain. You may remember hearing about it in science class. It regulates your temperature, your feelings of hunger, your mood, your sex drive, and even your blood pressure, according to the Endocrine Society

The hypothalamus releases a gonadotrophin-releasing hormone (GnRH) which signals the follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estrogen to control menstruation in the body. FSH and LH are responsible for your ovary releasing an egg. 

When the hypothalamus doesn’t produce GnRH, your body is thrown out of wack and this could lead to the disappearance of your period.

Why might the body stop releasing GnRH? There are varying reasons but they include not eating enough food, having an eating disorder, exercising too much, having low body fat, emotional stress, or having poor nutrition. 

With .2 to 4 percent of young women and adult women living with an eating disorder, finding treatment as soon as possible is essential. Moreover, many young women participate in a form of exercise, but they do not often keep up with their caloric intake, putting them at high risk for the condition. Eating disorders include anorexia, bulimia, and binge eating disorder. 

The brain believes that the body is in immense distress and it essentially goes into survival mode. 

The majority of women with this condition severely restrict their caloric intake or exercise two to three hours a day. And it’s common in athletes who have a low body mass index (BMI). 

For athletes, usually participating in a sport like ballet, figure skating, gymnastics, and cross-country running, this condition can cause irreversible bone loss and stress fractures, according to a study published in Pediatric Annals.

Diagnosing and testing for hypothalamic amenorrhea

It’s difficult to look at someone and know they have this condition. It’s also difficult for the patients themselves to know they have imbalanced hormones or low estrogen. 

A healthcare practitioner will want to rule out other conditions before diagnosing hypothalamic amenorrhea, like polycystic ovary syndrome, pregnancy, or adrenal gland disorders. 

A doctor will provide a blood test to check hormone levels, a pelvic exam, have the patient take a pregnancy test, or conduct an MRI of the pituitary gland, which is an endocrine gland that releases hormones. 

Hormonal blood tests measure the levels of FSH, LH, human chorionic gonadotropin (hCG), and prolactin. If the blood work shows low levels of FSH and LH, this may indicate hypothalamic amenorrhea. If the blood work comes back with high levels of prolactin, this may mean the patient has a benign tumor on the pituitary gland. 

To prepare for your doctor’s visit, write down any details about your symptoms and the date of your last period. Bring in any key medical information and be honest about any supplements you’re taking. The doctor will also want to know about your family history so make sure to review any information that can be helpful. 

Treatment

For most people, a doctor will suggest a lifestyle change. Since many people who have the condition are exercising or limiting food intake, doctors will recommend limiting exercise, working on gaining weight or finding a way to reduce stress. 

Patients with an eating disorder or high stress may benefit from seeing a mental health professional. With .2 to 4 percent of young women and adult women living with an eating disorder, finding treatment as soon as possible is essential. Moreover, many young women participate in a form of exercise, but they do not often keep up with their caloric intake, putting them at high risk for the condition. 

Those struggling with stress, which can have a huge impact on reproductive function, may also benefit from seeing a therapist or looking to control their stress factors. 

Treatment varies from person to person and the length of time will depend on many factors like age, weight, and genetics. On average, it takes a person three to six months for their period to return, however, this is a very broad generalization. 

If you don’t have a period for three months and are growing concerned, contact your healthcare provider for an appointment. Typically, 71 percent of patients fully recover. 

It is important, however, to know that this condition is reversible and can be managed if the patient implements a nutritious diet, weight, and livelihood. 



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