Hypothalamic amenorrhoea is probably the reason your period has gone missing.
Hypothalamic amenorrhoea (HA) or loosing your period sounds harmless enough, convenient even. Although commonly seen in female athletes, HA can pop up during times of increased stress, reduced energy intake, weight loss and along side intense exercise regimes. HA can occur with or without a the presence of an eating disorder. Read on to find out why it’s important to address HA to support your overall health and wellbeing.
What is hypothalamic amenorrhoea?
Hypothalamic amenorrhoea (HA) is the medical term for when your period disappears and other medical conditions including pregnancy have been ruled out.
HA is a protective mechanism that the body uses to shut down ovulation and in turn menstruation because now isn't a safe time to conceive a baby.
HA occurs when the normal functioning of the hypothalamic pituitary axis and the hypothalamic ovarian axis is disturbed.
Menstruation does not occur due to abnormal signalling between the hypothalamus and the pituitary gland and is characterised by low GnRH secretion which leads to insufficient LH and FSH both needed to maintain folliculogenesis and normal ovulatory function.
As a result signalling is not received by ovarian granulosa cells to product estradiol and endometrial thickening does not occur during the follicular phase resulting in a missed bleed/period.
The main causes of HA include:
weight loss
illness
insufficient energy intake
increased stress levels
excessive and intense exercise
Who is at risk of developing HA?
women with low calorie intake, restrictive diets, eating disorders
female athletes or those undertaking intense exercise
women experiencing high levels of physical or mental stress
women experiencing a combination of the above
How do we address HA:
dietary review and plan implemented to increase energy intake and correct nutrient deficiencies
working with a multi-modality team to diagnose eating disorder or address disordered eating behaviours where required
support stress levels - mindfulness based techniques, nervous system support, referral to psychologist if required
implement plan for modifying exercise/training routine
Why is it important to address HA?
Due to the impact that HA has on estrogen production, the health consequences of HA are mainly associated with the loss of estrogens protective mechanisms on cardiovascular, bone and psychological health.
It is important to note that cases of HA can be masked by hormonal contraception i.e. the oral contraceptive pill, depo-provera, mirena. Signs and symptoms of HA may then only present when contraception is ceased.
It is also important to note that HA is commonly associated with disorded eating diagnosis but may also occur without a diagnosed eating disorder or patterns and behaviours typically associated with eating disorders. Working with a trusted health care practitioner can help to identify the underlying reasons for HA and provide support so that you are able to address issues in a way that considers your individual situation.
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