What causes hypothalamic amenorrhea?

Have you noticed that you are no longer getting your period or only have very light bleeding/ spotting?

Are you finding that you feel cold a lot, lack energy or are feeling very tired?

Have you experienced low mood, been feeling anxious or had trouble sleeping?

Have you recently lost quite a bit of weight, dropped to a low body fat percentage, experienced a lot of emotional stress or embarked on a new diet or exercise regime?


If you answered yes to all of these questions then you may be dealing with hypothalamic amenorrhea. Hypothalamic amenorrhea is a condition that occurs in women of reproductive age and it is a condition that causes an individual to lose their period (or just experience light spotting at the time of their period). The National Institute of Clinical Excellence (NICE) recommends diagnosing the condition upon "the cessation of menstruation for 3–6 months in women with previously normal and regular menses". So it isn't just the occasional late or missed period, it describes losing your period for several consecutive months.


The cause of the disruption in the menstrual cycle is a shift in hormone balance within the body. The hypothalamus, which is a gland in the brain that regulates body processes, slows or stops releasing gonadotropin-releasing hormone (GnRH) . GnRH is the hormone that starts the menstrual cycle. As the condition affects the release of hormones regulating the menstrual cycle, it very often also causes problems with ovulation and fertility too. Many women will seek to address their hypothalamic amenorrhea when they are looking to get pregnant or are keen to conceive in the future.


WHAT CAN CAUSE HYPOTHALAMIC AMENORRHEA?

Often individuals end up with hypothalamic amenorrhea from doing things that they consider "healthy". They may begin a very gruelling exercise regime in order to try and get into shape or they may cut out all carbs/ sugars or fats from their diet in the pursuit of "good health". However both food restriction and too much exercise can be stressors on the body. In order for the body to prioritise fertility, to ovulate regularly and to have regular periods - it needs to know that it is a good time to conceive i.e. that there isn't too much stress on the body and that resources aren't too scarce. Each of the following factors can communicate to the body that it isn't a good time to conceive/ that times are tough and that reproductive functions should be shut off:


Over-exercising and/or not eating enough

Whilst gentle movement and exercise is great for mental and physical health, exercise also puts stress on the body. If a women is doing too much exercise, the body assumes that times are tough and that is isn't a good time to prioritise reproductive functions. Exercise can especially have a very negative effect on fertility when someone is also restricting or limiting the types of foods or amounts of foods that they are eating. A body in a calorie deficit will just be prioritising staying alive and will not allow for non-essential functions such as reproduction.


Not eating enough variety/ cutting out food groups or macro-nutrients

Many individuals, in the pursuit of "good health", may cut out food groups from their diet. They may embark, for example, on a low fat diet. Alternatively they may cut out or cut back on sugars and carbs. However each of these forms of restriction communicates to the body that resources are scare and that it isn't a good time to conceive or to prioritise reproductive functions. Fats (especially the types of fats found in things like olive oil, avocados, walnuts and oily fish) are very important for the production and regulation of hormones within our body so not eating enough fats can directly lead to hormonal imbalance. Also, when the body isn't getting enough carbs, it can go into "starvation mode" - of course, if there isn't enough energy to sustain the women, the body will certainly not want her to start thinking about having children. So restrictive diets can cause hypothalamic amenorrhea.


Fasting for very long periods

The benefits of intermittent fasting or time-restricted eating (i.e. giving your body a break from food for 16-18 hours during the day) are now well publicised. However if intermittent fasting is taken to the extreme and a women doesn't eat for very long-periods of time, the body can again think that times are tough and resources are scare, and shut down her reproductive functions. So again, a woman could be pursuing something that she thinks is "healthy", however the effects of intermitting fasting are very different on a woman's body to a man's body. The key in maintaining fertility and a good, regular menstrual cycle, is ensuring that the body doesn't think that times are too tough - that it knows that there are plenty of resources and can prioritise reproduction.


Going through a lot of stress

Emotional stress as well as physical stress can take its toll on the body and on hormone balance. Going through a lot of life changes, travelling to a different time-zone, not sleeping enough, going through a break-up and dealing with a lot of pressure at work are all examples of things that could place additional stress on the body. This stress could negatively affect hormonal balance and in turn stop menstruation from occurring.


Losing lots of weight or getting to a very low body fat percentage

Woman have a higher body fat percentage than men for a reason. Women need the extra fat on their body to protect their body in times of pregnancy. The extra fat is there are an additional resource in case times are tough and the body needs to rely on this fat to provide energy to a foetus or breast-feeding baby. This is why, if a woman loses too much weight or drops to a low body-fat percentage, she could find that she loses her period and stops ovulating. This body-fat is there for a reason and the body will again think that resources are scare and times are tough if there isn't enough of it.


In order to treat hypothalamic amenorrhea it is important to get the body back to a place where it knows that there isn't too much stress, that it is a time of abundance and that resources are plentiful. If you suspect that you may have hypothalamic amenorrhea, it is important that you seek out help from your doctor who will be able to rule out other causes for your lost period before giving you a diagnosis. If you have already been diagnosed with hypothalamic amenorrhea or are struggling with your fertility as you are not getting your period, please reach out to us at info@thefoodtherapyclinic.com to book in a free consultation. Often addressing the causes underlying the condition, such as over-exercising, extreme stress, or under-eating can help individuals to get their period back and restore their fertility.


“I’m thankful for my struggle because without it I wouldn’t have stumbled across my strength.” — Alex Elle