Understanding Functional Hypothalamic Amenorrhea
Functional hypothalamic amenorrhea (FHA) is a condition where you're not having a period because your brain isn't signaling your ovaries to do so. If you’re experiencing amenorrhea (absence of a period), it’s essential to understand what’s happening in your body and when you should seek medical evaluation.
What Is Amenorrhea?
Amenorrhea refers to the absence of a period and is classified into two types:
Primary Amenorrhea: When someone has never had a period.
Secondary Amenorrhea: When someone who previously had periods stops menstruating for six months or more.
There are many possible causes of amenorrhea, but FHA is one of the more common ones related to lifestyle and stress factors.
How Does a Normal Menstrual Cycle Work?
To understand why FHA happens, we need to go over the basic steps of the menstrual cycle:
Egg Availability: Your ovaries contain all the eggs you’ll ever have. Each month, a group of eggs is recruited, and one follicle grows in response to follicle-stimulating hormone (FSH) from the brain.
Estrogen Production: As the follicle grows, it produces estrogen, which helps thicken the uterine lining in preparation for pregnancy.
Ovulation: When estrogen reaches a high enough level, the brain releases luteinizing hormone (LH), triggering ovulation (the release of an egg).
Progesterone Production: After ovulation, the empty follicle becomes the corpus luteum, which makes progesterone. If no pregnancy occurs, progesterone levels drop, leading to a period.
This process relies on communication between the brain and ovaries. When something disrupts this communication, ovulation and periods can stop.
Why Does FHA Happen?
FHA occurs when the brain does not send out enough FSH and LH to stimulate the ovaries. This results in low estrogen levels, which can have serious health implications. The most common causes of FHA include:
Caloric Restriction & Disordered Eating: When your body perceives that it doesn’t have enough energy, it prioritizes survival over reproduction.
Excessive Exercise: Intense exercise, especially without adequate nutrition, signals to the brain that it’s not a good time to support a pregnancy.
Chronic Stress: High levels of stress increase cortisol, which can suppress the hypothalamus and affect menstrual cycles.
Underlying Medical Conditions: Chronic illnesses, inflammatory diseases, and significant weight loss can also contribute to FHA.
Why Is Low Estrogen a Problem?
Estrogen is crucial for overall health, not just reproduction. Low estrogen levels can lead to:
Bone Loss & Osteoporosis: Estrogen helps maintain bone density, and prolonged deficiency increases the risk of fractures.
Heart Health Issues: Estrogen plays a role in cardiovascular protection.
Cognitive & Mood Changes: Many people with FHA experience mental fog, low energy, and mood disturbances.
Vaginal & Sexual Health Problems: Low estrogen can cause vaginal dryness, pain, and decreased libido.
Diagnosing FHA
FHA is a diagnosis of exclusion, meaning we must rule out other potential causes of amenorrhea first. This includes:
Checking FSH, LH, and Estrogen Levels: In FHA, FSH and LH are low, and estrogen is also low.
Ruling Out PCOS: Unlike FHA, PCOS usually involves normal or high LH and estrogen.
Screening for Thyroid & Pituitary Disorders: Conditions like hypothyroidism and high prolactin levels can also cause absent periods.
Ovarian Reserve Testing: We check to ensure ovarian failure or premature menopause isn’t the cause.
How Do We Treat FHA?
The good news is that FHA is often reversible with the right approach. Treatment focuses on addressing the underlying cause:
Increase Caloric Intake: Ensuring adequate nutrition is key, especially if undereating is a factor.
Reduce Exercise Intensity: Cutting back on extreme workouts allows your body to recover.
Manage Stress: Mindfulness, therapy, and lifestyle changes can help lower cortisol levels.
Estrogen Replacement Therapy: If estrogen levels are too low, supplementation may be necessary to protect bone and heart health while your body heals.
Final Thoughts
If you’re experiencing amenorrhea, don’t ignore it. Your period is a vital sign of your overall health. If you suspect FHA, work with a healthcare provider to identify the cause and create a plan for recovery. Healing from FHA takes time, but prioritizing your health is always worth it.
