• Alex Bovell

Hypothalamic Amenorrhoea


Photo Source: @brightgirlhealth


Hypothalamic Amenorrhoea is something that I’ve experienced as a consequence of my eating disorder. Losing my period affected me really badly as I was extremely worried I’d never be able to have children, and that’s something i’ve always wanted in life! Going through this has made me extremely passionate about educating women on their delicate cycles and how important it is to nourish your body and support this process.


Hypothalamic Amenorrhoea occurs when menstruation (your period) stops for several months due to a problem involving the hypothalamus. It’s known as secondary amenorrhoea which means, periods have been regular however now they’ve ceased for 3 months or longer.


The hypothalamus lies in the centre of the brain, controlling fertility & reproduction. It’s responsible for producing gonadotropin-releasing hormone (GnRH) which signals the production of hormones required for the egg to mature and for ovulation to occur, such as follicle-stimulating hormone (FSH) and luteinizing hormone (LH). Consequently, FSH and LH signal the ovaries to produce estrogen which thins the cervical mucus and (with progesterone) - prepares the uterus for a fertilized egg.


Sometimes the hypothalamus stops producing GnRH, which, consequently, reduces the amount of hormones produced (FSH, LH, and estrogen). It’s a domino effect like many processes in the body, if one part of the sequence (1 domino piece) is missed, everything is messed around! Therefore, in this case, ovulation and menstruation stop, resulting in infertility.


Some people say, "I don't want kids though, so what's the problem?". Unfortunately, there's another huge issue that arises with Hypothalamic Amenorrhoea which is bone loss. This occurs as a result of the lack of estrogen in the body, as estrogen is important in bone health in the following ways:

  • estrogen stimulates bone formation

  • estrogen suprresses bone resorption - when bone is broken down and the minerals are released

  • estrogen inhibits osteoclast function - osteoclasts are responsible for breaking down bone

  • estrogen plays a role in Vitamin D assisting bone production

Around half of our body's peak bone mass is formed during puberty and almost 90% by the time we reach 18 years old. This means if you've had a low body fat % during your adolescence and teenage years, your bone mass is going to suffer. Additionally, once you reach 30 years old, you lose approximately 1% of bone mass density every year. However, if you have Hypothalamic Amenorrhoea, the rate of bone loss is approximately 5% per year, the same as is seen in menopausal women. This is extremely frightening as it's 5x greater bone loss than should occur.


CAUSES

This abnormality in which GnRH stops is caused by poor diet, chronic & excessive stress and/or overexercise. Basically If you have hypothalamic amenorrhea, it means you're not getting enough calories in your body which alters the signalling pathway/domino effect in the brain that regulates the menstrual cycle. Under-eating, dieting & excessive exercise places an immense amount of stress on the body. That’s the reason why it’s common in women who have Anorexia Nervosa and the reason mine developed.


Women with this condition may be:

  • Severely restricting their caloric intake either through dieting or perhaps they're under eating without even realising

  • Exercising more than two to three hours per day

  • Under major psychological stress.

It's a common pattern seen in performance athletes and dancers as well as women with anorexia nervosa, with the common denominator being very low body fat percentages and significantly low Body Mass Index (BMI). In this situation your brain doesn’t get adequate energy or macronutrients to produce the hormones that allow follicle maturation and ovulation. Consider this from another, simple perspective... When you're under psychological or physiological stress your body knows it's not in a place to reproduce and fall pregnant due to the danger.


SYMPTOMS

Besides missing a period, or extremely light bleeding during menstruation. There are other common symptoms of Hypothalamic Amenorrhoea including:

  • Low libido

  • Feeling cold often

  • Depression and anxiety

  • Difficulty sleeping

  • Increased hunger

  • Low energy

MY EXPERIENCE

I developed Hypothalamic Amenorrhoea when I was under an immense amount of stress both physically and mentally. I was obsessive with my diet, lifestyle and routine, working multiple jobs, studying and overfilling my task list. Additionally, the amount of calories I was eating was far too low, way below my daily requirement. My body started showing symptoms beyond losing my period, that the lifestyle I was living was damaging... including depression, fatigue, anxiety, acne etc.


TREATMENT

I read a lot about Hypothalamic Amenorrhoea whilst in the depth of my anorexia nervosa. Honestly, it was SCARY! What I was reading was the opposite of what I was doing. Please remember this is something that really does take TIME! It took me 2-3 years, of constant efforts for my period to return and it was such an amazing day!


I had to completely overhaul my lifestyle and my diet.


1. DIET

Eat, eat, eat & eat! You're body is starving and needs nutrients and energy. Maybe that means you will have to gain a few kgs and maybe not. That really needs to be ignored because this is a SIGN you are starving and malnourished. STOP counting calorie, they're irrelevant... get in tune with your body. It's difficult and I understand that, I gained weight and it was hard to accept but on the plus side, I got my period back, I'm one-step closer to being able to have a healthy body (baby making body).


2. REDUCE PHYSICAL STRESS

Consider the amount you're trying to fit into your day. How much are you loading onto your plate? Are you someone who is hitting F45 7x per week and only doing HIIT training. You need to look at your routine and swap out some of these physically demanding exercises for lighter activities. Trust me, I've done this and I understand that's difficult for someone who's done this their entire life, it really does become an addiction! Start walking, doing yoga & pilates. Stop running, start walking. Swap weights for yoga. Stop going to CrossFit and begin practicing pilates. You almost need to stop all intense exercise (remember it's NOT forever).


3. REDUCE MENTAL STRESS

Consider yoga, meditation, deep breathing. Meditation sounds hard but try simply 5 minutes during the day, schedule it in as you would an exercise class.


Are you suffering from mental health illnesses? You may need to speak to someone, a family member, friend or even a psychologist and that's totally okay!