Struggling with Irregular or Absent Periods? It Might NOT be caused by PCOS

If you've been grappling with irregular or absent periods, you may have heard the term "PCOS" (Polycystic Ovary Syndrome) thrown around. However, there's another condition that can mimic the symptoms of PCOS while being entirely different—Functional Hypothalamic Amenorrhea(FHA). FHA affects a reported 1.62 million women between the ages of 18 and 44 years in the US and a reported 17.4 million women worldwide. In athletes, the prevalence of FHA is estimated to range from 6-43% depending on the sport discipline. Don’t consider yourself an athlete but exercise regularly? If so, this condition can still impact you. Studies have found that “non-athletes” following the same training scheme as athletes, often also experience FHA. In fact, even in non-athletes who exercise consistently, only 14% menstruate regularly. So whether you classify yourself as an athlete or consider yourself a “weekend warrior” this condition can impact you. This condition also impacts women who don’t train like athletes but instead experience other causes of the development of FHA, including high stress, which in the world we live in today, is most of us. 

Understanding Hypothalamic Amenorrhea

Hypothalamic Amenorrhea is a condition characterized by the absence of menstrual periods due to disruptions in the hypothalamus, a crucial part of the brain that regulates the menstrual cycle. Unlike PCOS, which involves hormonal imbalances, Hypothalamic Amenorrhea is primarily a result of lifestyle factors and stress. These lifestyle factors cause a suppression of an important hormone regulating hormone known as gonadotropin releasing hormone, or GnRH. This suppression in the normal pulsatory release of GnRH, causes a disruption in the release of two other essential hormones for regular menstruation, follicle stimulating hormone (FSH) and luteinizing hormone (LH). 

The GnRH pulsatility in the brain can be altered by numerous neurotransmitters and neuromodulators including: 

  • Neuropeptide Y
  • Corticotropin-released hormone (CRH) 
  • Leptin 
  • Ghrelin 
  • B-endorphins
  • Kisspeptin and Orexin A 

Who is at Risk?

Hypothalamic Amenorrhea is more commonly observed in women who:

  1. Engage in intense physical activity: Athletes, particularly those involved in endurance sports, are at a higher risk.
  2. Undergo significant weight loss or have a low BMI: Extreme calorie restriction, rapid weight loss, or an excessively low body mass index can disrupt the hypothalamus.
  3. Experience chronic stress: High-stress levels, whether emotional or physical, can negatively impact hormonal regulation.
  4. Have a history of eating disorders: Conditions like anorexia or excessive exercise in combination with inadequate calorie intake can lead to Hypothalamic Amenorrhea.

Diagnosis and Health Implications

Diagnosing Hypothalamic Amenorrhea involves ruling out other potential causes, such as PCOS or thyroid disorders, and assessing factors like a history of stress, excessive exercise, or restrictive eating. A medical professional may also perform hormonal tests to confirm the diagnosis.

The impact of Hypothalamic Amenorrhea on your health can be far-reaching:

  1. Bone Health: Absence of menstrual periods can lead to reduced estrogen levels, increasing the risk of osteoporosis and bone fractures even in your 20s and 30s!
  2. Fertility: Irregular or absent periods can make it challenging to conceive and lead women to assume that medication interventions like IUI or IVF are their only option when in reality this is not the case.
  3. Athletic Performance: Hormonal imbalances may hinder performance and athletic achievements.
  4. Emotional Well-being: Hormonal disruptions can lead to mood swings, depression, and anxiety.

While Polycystic Ovary Syndrome (PCOS) often takes the spotlight when discussing irregular periods, it's essential to be aware of other possible causes, such as Hypothalamic Amenorrhea. Understanding this condition, its risk factors, and its potential impact on your health is crucial for seeking appropriate medical care and making informed lifestyle choices.

If you suspect you may have Hypothalamic Amenorrhea, consult a healthcare professional experienced in women's health. Early diagnosis and management can help restore your menstrual cycle and protect your long-term well-being.


About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...