It is also known as functional hypothalamic amenorrhea (FHA). It is the most common type of secondary amenorrhea. It refers to a medical condition in which menstruation stops for several months due to any problem in the hypothalamus.
Hypothalamus is a major part of the brain located in the center and controls reproduction. It releases hormone namely Gonadotropin-releasing hormone that further control the process of ovulation and menstruation.
It is one of the most common and prevailing female disorder that occurs at the onset of puberty. If left untreated can create serious fertility issues. the most common causes of functional hypothalamic amenorrhea (FHA) includes
- Too less energy consumption
- Excessive exercise or physical work
- Much energy consumption
- Too much stress
Etiology of hypothalamic amenorrhoea:
The main mechanism involved in the absence of menstruation due to any problem in the hypothalamus is impairment in the release of the GnRH hormone. that further responsible to release follicle stimulation hormone (FSH) & luteinizing hormone (LH). These two hormones control the process of ovulation & menstruation as well as maintain the fertility of women. Impairment in the release of these hormones results in anovulation ANd absence of menstruation.
Symptoms of hypothalamic amenorrhoea:
The most common and prominent symptom of hypothalamic amenorrhea is missing periods or very light bleeding duration menstruation. However missing periods is not the one ans only confirmed sign as there are many causes of missing periods too so relate your health status with the other symptoms too .Other symptoms include
- Difficulty in sleeping
- Low libido
- Low energy levels
- Depression and anxiety
- Feeling cold often
- Increase appetite & hunger for food
How can I diagnose Hypothalamic amenorrhea by myself?
If you are missing your periods for continue 3 months in a to row than probably you are suffering from Hypothalamic amenorrhea. However, it’s not the one & only way to make a diagnose. You can also miss your periods due to
- Poly cystic ovarian syndrome
- Ovarian or uterine cancer
- Hormonal imbalance
Self diagnose is not recommended anyway. You need diagnostic test also to confirm your disease like
- Blood test
Therefore it is necessary to visit your gynecologist. A blood test will be recommended to check the hormone level in blood. Also, ultrasound is recommended to detect any internal injury or cysts to the reproductive organs. Results from this diagnostic test will generate an overall picture of your health status.
Consequences of hypothalamic amenorrhea:
Hypothalamic amenorrhea imparts a negative effect on the overall health of a female. Its consequences are not only limited to only reproductive organs. These are summarized as follows
Hypothalamic amenorrhea causes a low level of estrogen that is hypoesterogenemia. Estrogen is a potent vasodilator and its low level may give rise to premature CVD. One of the early signs of hypoesterogenemia is menstrual irregularities. this hypoesterogenemia has also found to e associated with uterine atherosclerosis that leads to early menopause.
Low estrogen level effects bone status significantly. estrogen stimulates the osteoblast activity of bones. Women with low estrogen levels have poor bone formation. Hypoestrogenemia impairs the absorption of calcium in intestine resulting in decreased bioavailability of calcium for bone reabsorption. Unavailability of calcium continues the cascade of bone losses in FHA women.
Hypothalamic amenorrhea at the onset of reproduction results in anovulation & infertility. Other serious consequences include
- Decrease vaginal lubrication due to low estrogen levels.
- Atrophic changes in uterine muscles & urogenital mucosa.
- Lack of endometrial thickening in the uterus that doesn’t let the fetus grow & developed inside the mother’s body.
- FHA increases the risk of miscarriages & pregnancy complications.
Hypothyroidism: The psychological impact of hypothalamic amenorrhea
Hypothalamic amenorrhea also affects the mental health of women in various aspects. It is revealed that low estrogen level results in a lower level of dopamine & serotonin that give rise to the onset of Depression. Furthermore, estrogen modulates many neurotransmitters & neuromodulators. Fluctuations in estrogen levels disturb the normal pattern of these neurotransmitters & contribute towards psychological changes in women. Women with FHA also suffers from some disturbing mental & psychological states including
- Mood impairments
- Binge eating disorder
It is also revealed through research & study that as compared to women with the normal menstrual cycle, amenorrheic women is reported to have greater internal feelings including
- Lack of self-control
Choice of treatment:
In the majority of the cases the main aim to treat FSA to regain & maintain the normal menstrual cycle. Oral contraceptive therapy or estrogen replacement steroidal drugs gives effective results. Infertility associated with FSA is hormonally based and need hormonal replacement therapy to induce ovulation. Here are the following strategies to
- Human menopausal gonadotropin (HMG) which is a combination of FSH ( follicle stimulation hormone) & LH ( leutinizing hormone) is available as injectable. this injection helps to stimulate ovaries to cause ovulation
- Leptin is recognized as a hormone that is the mediator of energy and regulates the appetite of food & metabolism. Low leptin level leads in the reduction of the release of GnRH. So leptin replacement therapy is a good option to treat hypothalamic amenorrhea.
- Females suffering from fertility problems associated with amenorrhea can be suggested by physicians to go for the notion of Vivo fertilization. It is a safe & effective method.
- Cognitive-behavioral therapy is a choice of treatment to combat with psychological stress-related yo FSA
Some general descriptions regarding FHA:
Is gynecologist is enough to consult?
A gynecologist is the health care provider having specialization in the diagnosis & treatment of genital organs. They handle and treat the cases very efficiently. But in order to manage the psychological impact associated with hypothalamic amenorrhea, a psychiatrist or dietician may be the part of your health care provider team. They can work as a unit to provide you the fas==speedy recovery & help to restore both physical & mental health.
Is FHA is a red alert sign for females?
FHA is not so much complicated & can easily be overcome by medications. Not bringing it into a serious concern will definitely cause more health-related issues. Females face difficulty in conceiving. miscarriages or other delivery complications. Therefore it demands attention before turning into a red signal.
Is treating infertility is the main goal of treatment?
FHA treatment focus to resume the normal menstrual cycle. It is difficult to maintain pregnancy in a female with an irregular mental cycle. If this cycle restores to the normal one then fertility issues related to FHA will automatically be solved. So the main aim is to treat FHA, not infertility which is the root cause.
Functional hypothalamic amenorrhea (FSH) is one of the most common prevailing disorders in young females. It required proper diagnosis & attention followed by treatment in the right direction. It should not leave untreated as it causes long health term consequences along with infertility and several other complications.
A student of Pharm D from University of Karachi. She has keen interest in all the attributes towards pharmacy especially community pharmacy and hospital pharmacy with an objective to make medications sound and safe. She loves to provide information about Pharmaceutical Analysis and Pharmacology in a best way so people with no medical background can understand.