There are common misconceptions about how hypothalamic amenorrhea / missing periods can arise. “Everyone” seems to know that women who have eating disorders or are Olympic-level athletes commonly lose their periods. What is much less well-known, however, is that women can lose their periods at much less extreme levels of calorie/food group restriction and exercise.
A big part of our book, No Period. Now What? is the survey of over 300 women that we completed, asking a variety of questions about factors leading to hypothalamic amenorrhea, steps taken to recover, and recovery success (as well as trying to get pregnant, pregnancy, and beyond.) From that survey we were able to get a much better picture of the range of women affected by hypothalamic amenorrhea.
Our last few posts have discussed the factors involved in acquiring HA: exercise and undereating, weight/weight loss, stress, and genetics, and also about how women who are not avid exercisers or “underweight” can have HA. But those posts can take a while to read through. So we put together an information sheet to help educate those experiencing missing periods / hypothalamic amenorrhea, as well as any others who might be interested (e.g. doctors, family members). In addition, we’re making the first chapter of our book, which describes the basics of hypothalamic amenorrhea, available for download. Enter your email address to receive an email with a download link for both. Please feel free to share the files: for example with your doctors, other women with HA, and friends or family members who might not understand why your periods are missing.
Update: I recently put together a video explaining these five factors, in case you prefer visual learning.
Hope this helps!! Any questions, please comment on this post or use the contact form!
In case you’re interested, references for the information sheet are listed below.
Understanding Hypothalamic Amenorrhea Information Sheet References
Causes of amenorrhea:
- Liu JH, Patel B, Collins G. “Central Causes of Amenorrhea.” Endotext.
Updated Mar. 1, 2016. http://www.endotext.org/chapter/central-causes-of-amenorrhea/4/
Effects of underfueling:
- Wade GN, Jones JE. “Neuroendocrinology of Nutritional Infertility.” American
Journal of Physiology: Regulatory, Integrative and Comparative Physiology. 287(6) 2004:
R1277-1296. doi: 10.1152/ajpregu.00475.2004
- “Balancing Calories to Manage Weight.” In Dietary Guidlines for Americans, 2010.
7th Edition ed. Washington, D.C.: U.S. Department of Agriculture and U.S. Department
of Health and Human Services, 2010. http://www.fns.usda.gov/sites/default/files/Chapter2.pdf
Exercise (stress) and hypothalamic amenorrhea:
- Hill EE, et al. “Exercise and Circulating Cortisol Levels: The Intensity Threshold
Effect.” Journal of Endocrinological Investigation. 31(7) 2008: 587-91. doi: 10.1007/BF03345606
- Loucks AB, et al. “Alterations in the Hypothalamic-Pituitary-Ovarian and the
Hypothalamic-Pituitary-Adrenal Axes in Athletic Women.” The Journal of Clinical
Endocrinology & Metabolism. 68(2) 1989: 402-11. doi: 10.1210/jcem-68-2-402
- Mastorakos GM, et al. “Exercise and the Stress System.” Hormones. 4(2) 2005:
Stress and hypothalamic amenorrhea:
- Berga SL, et al. “Recovery of Ovarian Activity in Women with Functional
Hypothalamic Amenorrhea Who Were Treated with Cognitive Behavior Therapy.”
Fertility and Sterility. 80(4) 2003: 976-81. doi: 10.1016/S0015-0282(03)01124-5
- Biller MK, et al. “Abnomal Cortisol Secretion and Responses to Corticotropin-
Releasing Hormone in Women with Hypothalamic Amenorrhea.” Journal of
Clinical Endocrinology & Metabolism. 70(2) 1990: 311-17. doi: 10.1210/jcem-70-2-311
- Brundu B. “Increased Cortisol in the Cerebrospinal Fluid of Women with Functional
Hypothalamic Amenorrhea.” Journal of Clinical Endocrinology & Metabolism.
91(4) 2006: 1561-565. doi: 10.1210/jc.2005-2422
- Caronia LM, et al. “A Genetic Basis for Functional Hypothalamic Amenorrhea.”
The New England Journal of Medicine. 364(3) 2011: 215-25. doi: 10.1056/
- Gianetti E, et al. “When genetic load does not correlate with phenotypic spectrum: lessons from the GnRH receptor (GNRHR).” Journal of Clinical Endocrinology & Metabolism. 97(9) 2012: E1798-807. doi: 10.1210/jc.2012-1264