HA: Hypothalamic Amenorrhea
PCOS is not the only case of a missing period. Hypothalamic Amenorrhea (HA) can present with many of the same symptoms and is due to problems arising with the hypothalamus. The hypothalamus sits at the base of the brain near the pituitary gland and plays a big role in hormone production and ovulation. If you've been struggling with missing or irregular periods, an experienced period nutritionist can help.
What is Hypothalamic Amenorrhea?
HA is the absence of your period caused by under-eating/disordered eating, excessive exercise and/or high stress. This is what leads to a disruption in the hypothalamic-pituitary-ovarian (HPO) axis. We see this disruption lead to dysregulated estrogen and a lot of negative effects on mental health, cardiovascular health and reproductive health.Getting a regular period is extremely important, we call it your 5th vital sign. It can be very dangerous to go long periods without one, potentially causing endometrial cancer.
You do not have to be underweight to experience hypothalamic amenorrhea, although it is common. Most of the HA clients we see have been intermittent fasting, gone keto or extremely low carb and paired that with hours of intense cardio daily. Women are not small men. Although we wouldn't give that advice to men either, it is exceptionally damaging to females and their hormones. Cutting out all sources of carbohydrates and sugars will suppress thyroid function therefore creating no energy for your body and slowing down every system. Hormone production will slow, your liver will become sluggish, digestion will slow, therefore leading to overgrowths like SIBO and more. This is what metabolic chaos and a missing period looks like as these diets are very stressful on the body. Hypothalamic Amenorrhea can be caused by environmental and emotional stressors (internally or externally generated) as well. These stressors could be anything that triggers inflammation in the body.
Hypothalamic Amenorrhea is diagnosed via FSH, LH and estradiol blood testing. If FSH, LH and estradiol are all low or estradiol is low and there is an elevated FSH in comparison to LH, then HA is presumed. However, if LH is elevated in comparison to FSH, it is more indicative of PCOS. Your healthcare provider should always rule out PCOS, pregnancy and/or Hypothyroidism first.
Two Types of HA: Primary & Secondary
Primary: Menstruation has not begun by age 16.
Secondary: Absence of menstruation for three consecutive cycles or a time period of 6 months in a woman who was previously menstruating.
Common Symptoms of Hypothalamic Amenorrhea:
Feeling cold often
For pre-menopausal women, getting a true period (with ovulation) regularly is essential for health. It means you are producing progesterone which is your calming, anti-inflammatory hormone that increases your metabolism, has anti-aging and anti-stress effects, balances other sex hormones and is extremely protective for your bones and heart. Most people with long term hypothalamic amenorrhea suffer from bone loss and low bone density. This is due to low progesterone and dysregulated estrogen.
Most doctors associate hypothalamic amenorrhea with low estrogen which isn't necessarily true but that is what we see on blood work. In our practice, we take it one step further and run HTMA testing on our HA clients. We often get signs that estrogen has been accumulating in the tissues, making it unusable and creating that "low estrogen" picture. It's very rare to have true low estrogen as everything in today's environment increases estrogen: stress, inflammation, xenoestrogens, phytoestrogens, PUFA's etc.
We rarely work to increase estrogen in our practice as we are root cause focused. Instead, we work to mobilize estrogen, increase progesterone (anti-estrogen) and improve estrogen detoxification/elimination. Estrogen activates the adrenal stress reaction and interferes with mitochondrial respiration. We see this increase free radical production and cause energy deficits which are not ideal. We need our body to produce energy in order to heal from any condition. Increasing estrogen is not the solution. We do not even consider estrogen to be this amazing "female hormone". Excess estrogen can be created by different pollutants that inhibit estrogen sulfation and decrease thyroid hormone. We want all systems to be functioning optimally!
How Do I Heal Hypothalamic Amenorrhea?
The simple answer is eat more and exercise less in order to reduce stress on the body. However, we know it's not that easy. In our practice, we follow a series of steps with our clients:
1. Reframe Your Mindset
2. Repair Your Relationship With Food
3. Repair Your Relationship With Exercise
4. Break Any Negative Cyclical Habits
5. Implement Restorative Medicine
6. Heal Your Adrenal Glands
7. Rebalance Your Nervous System
8. Build an Ongoing Support System
Hypothalamic Amenorrhea is not an easy or quick condition to heal from. It all stems from your mindset and how you perceive yourself. Almost every single one of our HA clients have struggled with an eating disorder which is really draining both mentally and physically. With social media being such a big part of our lives and the misrepresentation of women's natural bodies, disordered eating is on the rise sadly. We understand how hard it can be. Katie suffered from Hypothalamic Amenorrhea for years before she gained the strength to break free from diet culture and the fitness world. Although she was very hesitant at first, she actually took a year off from exercising altogether (other than walking) and did not restrict her eating at all. If she wanted to eat a large pizza all to herself, she would with no shame or guilt. She had quite a few episodes of binge eating which was expected but once her body was nourished, those episodes got fewer and fewer. She tried not to stress over it and honoured whatever her body asked for. Typically with our clients we do reverse psychology and slowly increase their calories (without tracking) and decrease their activity levels. It's important to work with a professional so that you don't take either end to the extreme. We teach them that there is no such thing as a bad food and to view all food as fuel- some foods are just more fuelling than others. The key is to really tune in with your body and trust your intuition. Your body gives clues and signs when it's in need of help, we teach you how to listen and act on those cues in order to restore your menstrual cycle.
After we have reframed your mindset and reversed some of your punishing habits revolving around food and exercise, we focus on healing your adrenal glands and nervous system. We take many different avenues to do this including; acupuncture, EFT, adaptogens, glandular's, mineral and nutrient replenishment, glutathione IV, breath work etc. These are just some of the tools we would consider using when working together, not all are necessary. In addition, we often recommend HTMA testing so we can get an idea of where your metabolism is at and how well you are responding to stress. This gives us an accurate depiction of how much healing needs to be done, where we should put our focus and how long this process will take. This test also looks at blood sugar and thyroid health which are usually under-functioning in HA women.
Both hypothalamic amenorrhea and PCOS can cause hormonal acne for similar reasons. The common denominator between these two conditions is a missing period. This means ovulation is not occurring and therefore no progesterone is able to be produced as explained above. Just like any hormone imbalance, this can result in acne or skin issues. With hypothalamic amenorrhea, even though there isn't usually a direct androgen elevation there could still be a relative elevation due to low progesterone levels. Most people suffering from hypothalamic amenorrhea also have a very under-active thyroid which can lead to acne.
Your period is a vital part of your health. If you are missing your period, it is time to investigate what's wrong. Check our 1:1 membership to work with our nutritionist so we can take the steps needed to get your body ovulating again! We offer in-person appointments in Toronto, ON and online worldwide!