Treating Hypothalamic Amenorrhoea

Aug 22 Written By Amy Parin

What is hypothalamic amenorrhoea (HA)?

Hypothalamic amenorrhoea is created by amenorrhoea, low or normal serum levels of gonadotropins, hypo-estrogenism, and abnormal patterns of hypothalamic gonadotrophin-releasing hormone (GnRH) secretion. HA contributes to around 34% of secondary amenorrhoea and is important as it can majorly affect one's bone health due to the lack of ovulation and insufficient sex hormone production. HA can be due to disruption of neuro-endocrine abnormalities such as decreased levels or absence of LH and FSH surges. Due to the decreased levels of LH and FSH, the ovarian granulosa cells do not receive signalling to produce estrodiol which therefore also prevents the thickening of the endometrial lining (Perkins, Hall, & Martin, 2001). This causes a lack of menstruation.

What causes HA?

Stress: Inability to cope with stress, psychological, mental or physical stress to the body.

Weight loss: even if they are still within the healthy weight range. Makes the body feel stressed.

Undereating: undereating deprives the body of its caloric needs and therefore prevents ovulatory cycles

Physical activity: increased levels of exercise can put stress on the body and prevent ovulation when energy intake is not adequate

Eating disorders: Are usually connected with under eating and psycholigical stress

Health Risks Associated with HA

Infertility: inability to conceive or fall pregnant due to a lack of ovulation and sex hormones.

Osteoporosis/ bone loss: due to the lack of circulating estrogen in your system

Cardiovascular Disease: Due to the lack of estrogen

Hypothyroidism: more likely to have reduced thyroidal axes and may experience hypothyroidism causing a decrease in basal metabolic rate.

Mental health problems: women with HA are more likely to experience depression and anxiety due to low levels of sex hormones

Treating HA using Nutrition

To manage hypothalamic amenorrhea the individual should focus on consuming enough food, regularly to ensure that the energy needs of the body are being met and within surplus. Ways to do this would be to ensure that you are having at least 3 meals per day with a serving of complex carbohydrates, protein, and healthy fat to ensure your macronutrient requirements are being met. This has proven to be an effective method of treating HA. A method of increasing caloric intake without having to consume more food volume would be to increase the number of healthy fats in the diet. Doing this helps to incorporate more energy-dense foods into the diet. Extra attention on nutrients such as calcium and vitamin D should be a focus in the diet to avoid osteoporosis and damage to the bone developing and to protect bone density whilst an irregular cycle is present (Gordon, Ackerman, Berga, Kaplan, Mastorakos, Misra, & Warren, 2017).

Nutritional Recommendations

Increasing intake of Healthy Fats:Increasing the intake of healthy fats helps to increase caloric intake and provides fats for healthy reproductive hormone production. For female hormones, it is beneficial to consume 20-35 % of your daily calories from fat. Fat also increases the absorption of vitamins such as A, D, E, and K which are all required for a healthy body and menstrual cycle (Bringer, Renard, Lefebvre, Hedon, & Jaffiol, 1995).

Consume 1-2 tbsp of healthy fats with each meal. Healthy fats include nuts and seeds, avocado, olive oil, olives and flax seed oil

Increasing calcium intake: Increasing intake of calcium rich foods to prevent osteoporosis and decreased bone density can occur due to a decrease in estrogen levels throughout the body. Increased calcium intake has been proven to promote bone health, decrease the risk of fractures and osteoporosis. While women are experiencing amenorrhoea and an absence of their period and irregular hormones, it could be suggested that they increase their intake of calcium rich foods in the meantime whilst working on regulating their cycle (Zhu & Prince, 2012). Aiming to consume about 1000mg of calcium a day is recommended (Sunyecz, 2008)

Increasing calcium intake can easily be achieved with a healthy diet. Suggestions include: Consuming more calcium rich food like spinach, broccoli, dark leafy greens, yoghurt, cheese, nuts and seeds (Sunyecz, 2008).