Period MIA? Understanding Hypothalamic Amenorrhoea and How to Heal

Amenorrhoea, or the absence of menstrual periods, is a condition that affects many women. It’s more than just a missing period - it’s a vital signal from your body that something deeper is going on that needs addressing. One of the most common types of amenorrhoea is ‘hypothalamic amenorrhoea’ - which we’ll be discussing today, a condition with some key drivers. While it may seem benign at first, unaddressed hypothalamic amenorrhoea can have long-term implications for your hormonal health, fertility, bone health, heart health, and more.

There are two classifications of amenorrhoea:

1. Primary amenorrhoea: When menstruation and/or physical development associated with puberty has not commenced by the expected age/s, usually 17 and 14 years old respectively. Or when the period has not started within two years of physical maturation associated with puberty commencing.

2. Secondary amenorrhoea:

• The cessation of periods for three or more consecutive months in individuals who previously had regular menstrual cycles or for six months in those with irregular cycles, during any of the years between the onset of menstruation and menopause. Hypothalamic amenorrhoea falls into this category. 

So what’s the deal with hypothalamic amenorrhoea?

This condition is not caused by structural abnormalities or hormonal disorders, such as PCOS, which drive other forms of amenorrhoea but rather by external stressors that impact the body’s energy balance and hormonal communication. Lets break it down: 

The hypothalamus is a small region of the brain. Think of it like the control centre of your brain - it regulates temperature, hunger cues, and aspects of the reproductive system. In hypothalamic amenorrhea, the communication between the hypothalamus and the reproductive system - the hypothalamic-pituitary-ovarian axis, or HPO axis - is essentially cut.

Gonadotropin-releasing hormone (GnRH) is a hormone released from the hypothalamus that orchestrates the menstrual cycle by stimulating the release of two hormones - luteinising hormone (LH) and follicle-stimulating hormone (FSH) - from another area at the base of the brain called the pituitary gland. These hormones then go on to drive other processes within the menstrual cycle such as ovulation. 

However, when the body is under threat, such as that caused by psychological stress, inadequate energy intake, excessive exercise, or low body weight, the hypothalamus halts the release of GnRH. Without adequate GnRH, LH, and FSH levels drop, and the menstrual cycle ceases. This is basically the body’s survival mechanism - it thinks it’s in danger, and it’s trying to protect itself. When your body is trying to survive, reproduction is not a priority. 

Some clues to suggest your loss of a period may be hypothalamic amenorrhoea include:

• Absence of menstrual periods for three or more consecutive months

• Signs of energy deficiency including fatigue, difficult concentrating, and mood changes

• Feeling cold frequently 

• Brittle nails

• Thinning hair

• Dry skin 

Let’s talk more about the causes of hypothalamic amenorrhoea:

1. Low Energy Availability

• Insufficient caloric intake, often due to restrictive diets or eating disorders. Or a mismatch between energy intake and expenditure, for example high levels of exercise without adequate nutritional replenishment.

2. Stress

• Emotional, physical, or psychological stress. Chronic stress puts your body into a state of percieved increases cortisol levels, which interfere with reproductive hormones.

3. Excessive Exercise

• Overtraining, particularly in high-intensity sports, can lead to energy depletion, especially relative to food intake as already mentioned. 

4. Low Body Fat Percentage

• Below a certain threshold, body fat levels can impair the production of hormones necessary for ovulation - women need at least 22% body fat to maintain a regular menstrual cycle. 

5. Other Factors 

• Acute illness, rapid weight loss, or significant life changes. 

Treating hypothalamic amenorrhoea requires a multifaceted approach that focuses on restoring balance to the body. Dietary and lifestyle interventions need to be key approaches, and herbs and nutritional supplements can be beneficial for added support.

1. Optimise Energy Balance

• Increase caloric intake to suit energy expenditure: Focus on nutrient-dense foods, including healthy fats, proteins, and complex carbohydrates. If you are someone with a high physical activity load, your naturopath can ensure that you’re eating enough to fuel your body.

• Address restrictive eating habits: Your naturopath can help you create a sustainable eating plan, but seeking psychological support from relevant practitioners, such as psychologists, may be essential to address psychological factors. 

2. Modify Exercise Routines

• Reduce high-intensity workouts and incorporate restorative activities like stretching or walking. And ensure that food intake matches energy expenditure. And of equal importance, prioritise rest and recovery days to allow your body to heal.

3. Manage Stress

• Mindfulness and relaxation: Finding psychological stress management techniques is vital. Practices like meditation and breath work, journaling and the use of journal prompts, and mindful practices are proven approaches. 

• Adaptogenic herbs: As naturopaths, we can employ herbs like Withania (Ashwaganda) or Rhodiola can support adrenal function and resilience to stress.

• Nervines and anxiolytics: Herbs like oats green or seed, passionflower, chamomile, and kava help to calm the nervous system. 

4. Support Overall Hormonal Health

• Make sure you’re reaching your protein, carbohydrate, and fats: A balanced diet is paramount for menstrual health - you can read more here!

• Nutrients: As naturopaths, we can consider specific nutrient supplementation on a case by case basis, including magnesium, B vitamins, vitamin D, and vitamin C which all play a role in supporting the hypothalamic-pituitary-ovary axis. 

5. Emotional and Psychological Support

• Counselling or therapy can be necessary to address underlying stressors, unresolved chronic stress, and disordered eating patterns. Building a strong support network can improve mental and emotional resilience.

The recovery process varies and is so dependent on the individual and their specific factors. Restoring the menstrual cycle often takes several months of support. Hypothalamic amenorrhoea is a clear message from your body that it needs more care, nourishment, and balance. While it may feel frustrating or overwhelming, the condition is reversible with the right approach and consistent care. By addressing the root cause/s through nutrition, stress management, and lifestyle adjustments, you can restore your cycle and support your overall wellbeing.

Reach out to our team today if you need support locating your missing period.