What is Hypothalamic Amenorrhea?

Functional hypothalamic amenorrhea occurs when the brain’s hypothalamus shuts down a woman’s reproductive system when it senses that the environment is not safe enough to create a baby. This occurs when the hypothalamus perceives too much stress on the body and consequently signals to the pituitary gland that it must stop secreting follicle-stimulating hormone and luteinising hormone, which are both required in order to ovulate. In order to keep you alive, the brain will disregard menstruation and redirect it’s limited energy towards basis bodily functions such as breathing and circulating blood. Carrying a baby requires a large amount of energy.

Common factors contributing to Hypothalamic Amenorrhea

• Weight loss: if you don’t provide your body with enough calories or have a very low body weight you will automatically enter fight or flight mode, which will disrupt the secretion of GnRH

• Excessive exercise: too much exercise increases cortisol levels and usually means there will be insufficient energy for other bodily functions such as reproduction

• Chronic psychological stress: when we are experiencing chronic stress, our sympathetic nervous system release hormones such a cortisol and adrenaline which disrupts the balance of the HPA axis

• Genetic predisposition: women with HA have been shown to have similar variants of genes which are involved in the deficiency of GnRH. This means some women’s reproductive systems are more sensitive to stress and low energy availability

Symptoms of Hypothalamic Amenorrhea

Common symptoms include:

• Irregular or no periods
• Low energy
• Brain fog
• Feeling cold often
• Difficulty sleeping
• Low libido
• Vaginal dryness
• Anxiety and depression
• Hair thinning or hair loss
• Brittle nails
• Night sweats

Long term complications of HA

• Bone loss (osteopenia / osteoporosis)
• Increased levels of unhealthy cholesterol and reduced levels of healthy cholesterol
• Cardiovascular disease

Strategies to help you manage stress

In a large number of of HA sufferers, the primary cause of their battle with the condition is stress. Stress impacts the hypothalamus directly by reducing signals to the pituitary gland, which consequently inhibits the production of FSH and LH leading to missing periods. Learning how to manage stress and regulate your emotions is therefore vital when recovering from HA.

Some techniques that may help you reduce and manage your stress include:

• Meditation
• Deep breathing technique (diaphragmatic works best for me)
• Gentle forms of yoga (yin and restorative have been most helpful for me)
• Spending more time out in nature
• Prioritising sleep in order to allow your body to rest and repair itself
• Creating a strong support network and surrounding yourself with people you can trust and ask for help when required

It is however common for major lifestyle changes to be made in order to recover, such as changing jobs or moving home in order to recover from HA.

The importance of macronutrients

In order to recover from HA, it is very important that you incorporate each macronutrient into your daily meals. Fats, protein and carbohydrates all play a different role in supporting the hypothalamus. This can be very challenging for those suffering with HA as they are prone to diets and restriction. I outline below why it is imperative that you incorporate each macronutrient into your meal plan when recovering from HA:

• Fats

Fats are very important during HA recovery because they are an easy way to ensure you are consuming enough calories, as they are the most energy-dense macronutrient. Fats also play a part in regulating hormones. For instance, without enough fat in the body, estrogen cannot be produced. This has a negative impact on the nervous system and will also cause both ovulation and menstruation to cease. Omega-3 fatty acids have been proven to help reduce inflammation in women with HA which is caused by low levels of estrogen. Omega-3 fatty acids have also been shown to help eggs mature.

• Carbohydrates:

The body’s preferred energy source is carbohydrates. It is therefore paramount for women with HA to incorporate enough carbs into their diet to ensure there is enough energy available to menstruate. If the body does not have enough glycogen available to use, the secretion of Luteinising hormone will be disrupted, serotonin levels will decrease and cortisol levels will rise. Low carbohydrate diets have also been shown to have a negative impact on relaxation and sleep cycles as a result of a lack of tryptophan.

• Protein:

Protein helps to synthesise our hormones and ensures our blood sugar and energy levels remain stable. While recovering, excess protein is discouraged as it uses a large amount of energy to breakdown. However, in order to create a regular menstrual cycle and to protect bones from osteoperosis adequate intake is required.

HRT

It is very common for endocrinologists and GPs to address the hormonal imbalances associated with HA by simply masking the problem and prescribing artificial hormones. However, HRT and birth control are not a helpful solution and do not solve the underlying problem. By consuming artificial hormones, you are preventing your natural cycle from resuming. Hormone replacement therapy does not stimulate ovulation or restore gonadotrophin release, which means it provides a false reassurance of regular periods and recovery.

Herbal remedies and vitamin supplements – which are most effective for HA?

Acetyl-L-carnitine

Acetyl L-Carnitine is an amino acid found to increase the activity of nerve cells and therefore impact LH and FSH levels. Research has shown that ALC can increase GnRH pulses from the hypothalamus and consequently increase LH levels. I recommend that you take 500mg on an empty stomach in the morning upon waking, followed by another 500mg later in the day with your afternoon meal.

Vitamin C

Vitamin C (also known as ascorbic acid) is a nutrient which primarily supports your immune system. It has also been shown to increase estrogen levels and help protect you from the damage caused by oxidative stress, which we are working hard to reduce during recovery from HA.

Vitex

Vitex agnus-castus fruit (also known as chasteberry) contains chemicals which can interact with female reproductive hormones. It has been proven to be quite effective for reducing anxiety and to relieving PMS symptoms, however there is not enough evidence to prove that it will restore your menstrual period. For some women, it has actually interfered quite dramatically with their hormone levels and has consequently delayed their recovery from HA. I therefore advise you to be very careful before trying this herb while you’re focusing on your recovery.

Flaxseeds

The consumption of flaxseeds has been demonstrated to increase ovulation and reduce the amount of stress hormones in the body including cortisol, norepinephrine and epinephrine. Decreasing these levels will therefore help the hypothalamus to wake up again. Flaxseeds also contain omega-3 fatty acids, which reduces the risk of heart disease and diabetes.

Omega 3

Omega-3 fatty acids can improve egg quality and delay ovarian ageing.