Hypothalamic amenorrhea is the absence of menstruation for several months due to impaired hormone production and regulation by the hypothalamus. Several behavioral and circumstantial factors may contribute to the development of this condition. Treatment is dependent on the cause for the hypothalamic dysfunction and may require dietary and lifestyle changes or the use of prescription medication to restore proper ovulation and menstruation.
Considered the main hub of communication that influences menstruation and controls reproductive function, the hypothalamus produces the hormone gonadotropin releasing hormone (GnRH). When released, GnRH triggers the production of additional hormones essential to menstruation, namely follicle stimulating hormone (FSH), estrogen, and luteinizing hormone (LH). If the hypothalamus ceases to produce GnRH, communication shuts down, stopping ovulation and menstruation.
Hypothalamus dysfunction may result from a variety of circumstances and behaviors. Women with a low body weight for their height or those who exercise excessively may develop hypothalamic amenorrhea. Eating disorders, such as bulimia and anorexia, may also induce symptoms. Extreme emotional stress can sometimes interfere with proper hypothalamus function, causing a disruption in hormone regulation. Additional factors that may contribute to hypothalamic amenorrhea may include the presence of a tumor and thyroid malfunction.
The most common, and obvious, symptom associated with hypothalamic amenorrhea is the absence of menstruation for three or more months. Some women may experience additional symptoms that can include vision changes and persistent headache. Medical attention should be sought if menstruation fails to start by age 16 or has regularly occurred and suddenly stops.
There are several diagnostic tests that may be performed to confirm a diagnosis of hypothalamic amenorrhea. Initially, a complete medical history is taken and a pelvic examination is conducted. In some cases, a pregnancy test may also be administered. A progestin challenge test may be performed, which involves the administration of progestogen, a hormonal medication, for ten days in an attempt to provoke menstruation. If the results of a progestin challenge test do no indicate positive results, blood tests may be recommended to measure hormone levels, including human chorionic gonadotropin (HCG), follicle stimulating hormone (FSH), and luteinizing hormone (LH). Additionally, a computerized tomography (CT) scan may be ordered to evaluate the condition of the pituitary gland and rule out the presence of a tumor or other irregularity.
Treatment for a hypothalamus amenorrhea may include dietary and lifestyle changes, as well as the administration of medication. Individuals for whom the condition was precipitated by excessive exercise may be instructed to limit their workouts and pursue less strenuous routines. Diet-induced hypothalamus dysfunction may be remedied by adopting healthier eating habits and consuming a nutritionally balanced diet. Women who are diagnosed with an eating disorder may require counseling or in-patient treatment before a determination may be made that drug therapy is necessary to treat the amenorrhea. If dietary and lifestyle changes do not work, fertility or oral contraceptive medications may be prescribed to trigger hormone regulation and restore ovulation and menstruation.
Women who develop hypothalamic amenorrhea are at an increased risk for developing osteoporosis and cardiovascular disease later in life. Reduced estrogen levels associated with hypothalamic dysfunction may contribute to bone loss and impair cardiovascular function. Medications may be administered to reduce one’s risk for these secondary conditions, but should not be taken by women who are or may become pregnant.