When a person loses their period, or begins to have irregular periods it can be a cause for concern. Cue a google search and suddenly you are self-diagnosing with PCOS or another scary big diagnosis. A diagnosis that is often under-reported is Hypothalamic Amenorrhoea (HA).
TLDR:
Hypothalamic amenorrhoea (HA) is a condition where menstruation stops for several months due to a disruption in the hypothalamic signals that control the menstrual cycle. It’s often caused by factors such as stress, significant weight loss, or excessive exercise. Nutrition can play a key role in the return of periods, particularly the role of high quality fats, tailored supplementation and appropriate energy intake.
What is hypothalamic amenorrhoea (or HA)?
Hypothalamic amenorrhoea (HA) is a condition characterized by the absence of menstrual periods for several months, arising from problems in the hypothalamus. This part of the brain regulates vital functions such as temperature, hunger, and hormonal activity, which includes regulation of the menstrual cycle.
So what causes HA?
Hypothalamic amenorrhoea is typically caused by significant physical or psychological stress that disrupts the hypothalamus’s normal functioning.
Key features might include:
- Excessive Exercise: Particularly common in athletes, strenuous exercise can significantly impact menstrual function.
- Severe Caloric Restriction and Weight Loss: Eating disorders such as anorexia nervosa or bulimia, or even unintentional malnutrition, can lead to HA.
- Stress: High levels of emotional or psychological stress can alter the brain’s hormonal balance, impacting menstrual cycles.
- Chronic Illness: Certain illnesses and conditions can disrupt the body’s hormonal balance sufficiently to cause HA.
What are some of the main symptoms of Hypothalamic Amenorrhoea (HA)?
The primary symptom of HA is the absence of menstruation, but other signs and symptoms may include:
- Fatigue and insomnia
- Low libido
- Changes in appetite
- Hair loss
- Osteopenia or osteoporosis (due to lower estrogen levels)
Diagnosing Hypothalamic Amenorrhoea
Diagnosing HA involves ruling out other potential causes of menstrual irregularity. This process may include:
- A physical check up by your GP or primary care provider and digging into your medical history
- Blood tests to check hormone levels, including estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone (LH)
- Imaging tests like an MRI to examine the hypothalamus and pituitary gland, or a pelvic internal ultrasound to check your ovaries and uterine lining.
How do you treat and manage HA?
The treatment of HA focuses on addressing the underlying cause(s) and restoring hormonal harmony.
- Reducing Physical Stress: Modifying exercise routines to lower intensity and frequency is often recommended. Sometimes this means stopping physical activity altogether to allow the body to re-calibrate
- Stress Management: Techniques such as yoga, meditation, and counseling can be effective. If you do have a lot of extra stress from life, work or personal relationships, it can be helpful to work with a psychologist to improve your nervous system regulation. Stress hormones such as cortisol levels can impact appetite, and weight maintenance.
- Medication: In some cases, hormonal therapies may be used to stimulate menstruation and to prevent long term complications like osteoporosis.
Read more about the impact of eating disorders on fertility and pregnancy
Nutrition Interventions for HA
Improving overall energy intake and possibly gaining weight can help in saying “bye bye” to HA. A dietitian can provide valuable guidance on balanced eating, and including the right nutrients. Nutrition strategies are crucial for managing and potentially reversing HA, as they focus on restoring hormonal balance and supporting overall reproductive health.
So where should we start when trying to manage HA?
Increase Caloric Intake
People with HA often need to increase their caloric intake to restore normal hormonal function. This is particularly important if HA is related to low energy availability or weight loss. Consuming sufficient calories can help restart menstrual cycles. This often involves consumption of a mixture of macronutrients. Ensure a balanced intake of carbohydrates, proteins, and fats. Carbohydrates are especially important as they can help to regulate the production of hormones like insulin, which in turn can influence reproductive hormones.
Focus on Healthy Fats
Incorporate sources of polyunsaturated and monounsaturated fats such as avocados, nuts, seeds, and olive oil. Omega-3 fatty acids, found in fatty fish like salmon and sardines, are particularly beneficial as they can help reduce systemic inflammation and support hormonal balance. Hormones, particularly steroid hormones such as estrogen, testosterone, and cortisol, are directly synthesized from cholesterol, which is derived from fat. Appropriate fat intake is crucial for well-working hormones.
Ensure Adequate Protein Intake
Protein supports overall health, muscle maintenance, and the production of hormones. Include a variety of protein sources, such as lean meats, fish, dairy, beans, and legumes in the diet
Don’t forget about the importance of micronutrients!
Iron, calcium, and vitamin D are crucial for bone health, which can be compromised in HA. B vitamins, particularly B12 and folate, are important for cellular processes including hormone function.
Aim for some regularity
Eating at regular intervals can help stabilize blood sugar levels and provide a continuous source of energy, which is important for hormonal health. It is also so much easier to get in a beautiful variety of foods when it is spread through multiple meals and snacks through the day.
Consider Supplements
Supplements can be helpful to target individual needs in a higher dosage than we are able to get from food. Depending on individual dietary limitations and nutritional needs, supplements such as vitamin D, calcium, and omega-3 fatty acids might be recommended. However, this is completely based on you and your dietitian as supplementation is very individualised.
Mindful Eating and Stress Reduction
Practices such as mindful eating can help improve the relationship with food and reduce stress levels, which is beneficial for restoring menstrual function. It can be helpful to focus on different temperatures, flavours, textures and your own feelings when you are eating food. We want to promote enjoyment with food and the experience of eating.
Who can I go to for help in managing or reversing Hypothalamic Amenorrhoea?
Managing HA effectively involves a holistic approach:
- Emotional and psychological support from professionals (psychologists or counsellors), family, and friends can alleviate stress and promote recovery.
- Regular check-ups with a healthcare provider (GP) to monitor bone density, cardiovascular health, and overall well-being are essential, especially if the condition persists.
- Seek out a dietitian to support you with your eating and healing journey. The aim is to provide a supportive environment for the body to naturally resume menstrual cycles and improve overall reproductive health. However, it’s important for anyone dealing with HA to work closely with healthcare professionals, including dietitians, GPs, endocrinologists and psychology, to tailor advice to their specific needs.
Final thoughts:
Whilst a diagnosis of hypothalamic amenorrhoea can feel a little alarming, it is often reversible with lifestyle adjustments and appropriate health care. If you suspect you have HA, it’s important to seek medical advice. Early intervention can help prevent long-term complications and restore normal reproductive function. Remember, you’re not alone, and support is available to manage this condition effectively.
