Functional Hypothalamic Amenorrhoea
Functional Hypothalamic Amenorrhoea (FHA) is a common cause of your period stopping when it has previously occurred. The latter is called ‘secondary amenorrhoea.’ FHA is the cause of secondary amenorrhoea in 20-35% of cases.
The brain (including the hypothalamus and pituitary gland), ovaries and uterus normally follow a sequence of events each month. The result, if you are not pregnant, is a menstrual bleed. Absence of menstrual bleeding can be caused by conditions affecting the hypothalamus, pituitary gland, ovaries, uterus, cervix or vagina. In FHA, the hypothalamus slows or stops producing the hormones needed to stimulate the ovaries to produce eggs and release hormones, and subsequently your ovaries don’t produce the hormones to stimulate your uterus and result in menstrual bleeding. It is associated with low body weight, low percentage body fat, eating disorders, strenuous exercise, stress and some medical conditions or illness.
What causes functional hypothalamic amenorrhoea (FHA)?
There are often multiple factors contributing to FHA. Occasionally there can be no obvious precipitating factor. Ultimately, FHA develops when there is a mismatch of energy intake versus energy expenditure, leading to relative energy deficiency.
When your body doesn't have enough energy, it stops non-essential functions, including ovulation. is does not necessarily mean you have an eating disorder, which sometimes people are advised, but rather that your energy intake is less than the energy required for your body’s basic metabolic needs at this current stage.
Decreased energy availability:
Sudden weight loss
Eating disorders
Food/calorie/nutrition Malabsorption (ie. add extra detail to explain this)
Increased energy expenditure:
Strenuous prolonged exercise
Extreme physical, nutrition and/or emotional stress
Severe illnesses
Contributing factors may also include:
Decreased energy availability, which can be caused by reduced calorie intake, sudden weight loss or malabsorption.
Excessive caloric expenditure, which may include strenuous prolonged exercise, especially if not supported by adequate nutritional intake in a low-stress environment.
High metabolic states such as severe illness or burns, traumatic brain injury or organ transplant.
Stress including extreme physical, nutrition and/or emotional stress, which negatively impacts the menstrual cycle because cortisol suppresses the hormonal pathway from the brain, ovaries and uterus. This stress can be caused by various factors, for example may include school or work demands, relationship difficulties or traumatic events.
Genetic predisposition may result in certain individuals being more suspectable to amenorrhoea developing.
What are the symptoms?
The most common thing you will notice is your period stopping for more than three months. Other symptoms you may also experience include loss of weight, fatigue, difficulty sleeping or even bone fractures. Most symptoms in FHA are due to minimal estrogen being produced from the ovaries.
Who is at risk of FHA?
Those with low body weight including eating disorders such as anorexia nervosa, excessive exercise especially in sports associated with low body weight such as ballet, gymnastics, long distance running, and chronic or excessive stress are most at risk.
How do I know if I have FHA?
FHA is diagnosed on your history, examination and blood tests. It is a ‘diagnosis of exclusion’; this means that there is no one test or ultrasound that confirms if you have FHA, but rather only once tests for other causes have come back normal, can FHA be diagnosed.
Can FHA impact my health other than not having a period?
The absence of a period is perhaps the tip of the iceberg regarding your health.
Most of the health impacts are related to inadequate estrogen being produced from your ovaries.
Some of the short and long-term impacts on your body include:
Estrogen is essential to strengthening bones. If you have low estrogen when you are young, it may increase the risk of bone fractures and osteoporosis.
If your period doesn’t return, it can be difficult to fall pregnant later in life.
FHA is associated with anxiety and depression.
Other symptoms may include sleep difficulties, hair loss and dry skin.
Addressing the root cause of your FHA is crucial for managing FHA. Whether or not long-term consequences of FHA are present depends on several factors including how long your period has been gone for and the cause of FHA. Early diagnosis and treatment are crucial for managing the condition, minimizing potential complications, and protecting long-term health.
How is FHA treated?
The goal of treatment is to restore your menstrual cycle and fertility. Treatment is directed towards the underlying cause. It may include optimising nutrition, finding the right balance between your exercise level and nutrition intake, and stress management techniques such as yoga or meditation. A dietician, exercise therapist, psychologist, endocrinologist and gynaecologist may be part of your care team.
What is the prognosis?
FHA is usually treatable with prompt diagnosis and management. Once the underlying cause is addressed, your menstrual cycle and fertility can often be restored. There is often however a significant lag time between addressing the underlying cause and your period returning, so it is important that you continue to consult your care team during this time.
When should I see Mikhaila?
If you previously had a regular period and it has not occurred for three months or more, please give us a call to make an appointment with Mikhaila.
Melbourne Gynaecological Care
If you’re ready to start your journey to better health with one of Melbourne’s best gynaecologists, Mikhaila welcomes you to make an appointment.