As women we often discuss our menstrual cycle as our bodies monthly report card. It gives us an insight into our overall health and can often give us clues to when things may have swung a little out of balance. When things swing completely out of balance we can lose our period completely.
Amenorrhea is defined as the lack of a menstrual bleed, and there are two types – primary and secondary.
Primary amenorrhea is when a female fails to have a menstrual bleed by the age of sixteen. This type of amenorrhea usually is associated with genetic or structural abnormalities. Secondary amenorrhea is different to primary in that it occurs in women who have previously had a healthy menstrual cycle and is diagnosed when a female hasn’t had a menstrual bleed for three months.
Common causes of Secondary Amenorrhea
- Not to state the obvious but…pregnancy, breastfeeding & menopause
- Underlying hormonal imbalance e.g. Poly Cystic Ovarian Syndrome (PCOS)
- Functional Hypothalamic Amenorrhea (we will discuss this in more detail below because it is really common to see in clinical practice)
- Thyroid disease e.g. hypothyroidism
- Certain medications – antipsychotics, cancer chemotherapy, antidepressants, blood pressure drugs and allergy medications
- Recreational drug use – cocaine & opioids
- Structural abnormalities in the reproductive system
Out of the list above, one of the more common reasons we see women of reproductive age experience secondary amenorrhea is due to Functional Hypothalamic Amenorrhea.
Functional hypothalamic amenorrhea (FHA) is classified as a neuroendocrine disorder, and involves the hypothalamus, an area in our brain that controls reproduction. Our hypothalamus produces a hormone called gonadotropin-releasing hormone (GnRH). This hormone is involved in signalling the production of other hormones needed for our egg to mature and for ovulation to occur, such as follicle-stimulating hormone and luteinizing hormone (which rises after ovulation).
These two hormones (FSH and LH) signal our ovaries to produce oestrogen progesterone, our sex hormones that balance our monthly menstrual cycles, and stimulate the thickening and shedding of our endometrial lining.
What causes Functional Hypothalamic Amenorrhea
- Emotional and psychological stress
- Low calorie intake
- Macro and micro-nutrient deficiencies – these can occur with disordered eating habits, poor dietary choices, and poorly planned strict plant based diets.
- Excessive physical exercise (the body can perceive this as stress)
- Imbalance between energy input (food) and energy output (physical activity)
- Major weight fluctuations
When our body is in a stressed or malnourished state, it simply does not want to reproduce – it is prioritising survival over reproduction.
At a more physiological level the body starts releasing a new hormone called corticotrophin-releasing hormone (CRH) from the hypothalamus in response to stress. This hormone suppresses the production and release of gonadotropin-releasing hormone (GnRH) and this in turn limits our capacity to release our sex hormones, ovulate, and produce a menstrual bleed.
By identifying the trigger factors and addressing them through targeted dietary and lifestyle advice women suffering from Functional Hypothalamic Amenorrhea should expect to see their period resume as normal.
Below are some simple recommendations to address Functional Hypothalmic Amenorrhea, however we always recommend booking in with a qualified Naturopath for an individual assessment and treatment plan if you have lost your period and want to find out why.
Balance your energy input and output by
- Increasing intake of nutrient dense foods – focusing on macro nutrients such as healthy fats, protein, and complex carbohydrates.
- Reducing high intensity exercise
- Participating in gentle, restorative, and stress relieving practice – yin yoga, walking in nature, stretching, deep breathing and meditation.
- Allowing yourself to enjoy meals that may not be considered traditionally ‘healthy’ in moderation.
- Identifying your relationship with food and acknowledging if it needs some extra support – talking with a psychologist or counsellor to improve this relationship.
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