Hypothalamic amenorrhea is the absence of menstruation due to impaired hormone production and regulation by the hypothalamus. Behavioral and circumstantial factors can contribute to the condition, and treatment depends on the cause and may require dietary and lifestyle changes or prescribed medications. Women with hypothalamic amenorrhea have a higher risk of developing osteoporosis and cardiovascular disease.
Hypothalamic amenorrhea is the absence of menstruation for several months due to impaired hormone production and regulation by the hypothalamus. Several behavioral and circumstantial factors can contribute to the development of this condition. Treatment depends on the cause of the hypothalamic dysfunction and may require dietary and lifestyle changes or the use of prescribed medications to restore proper ovulation and menstruation.
Considered the major communication hub influencing menstruation and controlling reproductive function, the hypothalamus produces gonadotropin-releasing hormone (GnRH). When released, GnRH triggers the production of additional hormones essential for menstruation, namely follicle stimulating hormone (FSH), estrogen and luteinizing hormone (LH). If the hypothalamus stops producing GnRH, communication stops, interrupting ovulation and menstruation.
Hypothalamus dysfunction can result from a variety of circumstances and behaviors. Women with low body weight for their height or those who exercise excessively can develop hypothalamic amenorrhea. Eating disorders, such as bulimia and anorexia, can also induce symptoms. Extreme emotional stress can sometimes interfere with the proper function of the hypothalamus, causing hormone regulation to disrupt. Additional factors that may contribute to hypothalamic amenorrhea may include the presence of a tumor and a malfunctioning thyroid gland.
The most common and obvious symptom associated with hypothalamic amenorrhea is the absence of menstruation for three or more months. Some women may experience additional symptoms which may include vision changes and persistent headaches. Medical attention should be sought if menstruation does not begin by age 16 or has occurred regularly and stops suddenly.
There are several diagnostic tests that can be done to confirm a diagnosis of hypothalamic amenorrhea. Initially, a thorough medical history is taken and a pelvic exam is done. In some cases, a pregnancy test may also be administered. A progestogen challenge test may be done, which involves giving progestogen, a hormone drug, for ten days in an attempt to cause menstruation. If the results of a progestogen challenge test indicate no positive results, blood tests to measure hormone levels may be recommended, including human chorionic gonadotropin (HCG), follicle stimulating hormone (FSH), and hormone luteinizing (LH). In addition, a computed tomography (CT) scan may be ordered to evaluate the condition of the pituitary gland and rule out the presence of a tumor or other irregularity.
Treatment for hypothalamic amenorrhea may include dietary and lifestyle changes, as well as medications. Individuals for whom the condition has been made worse by excessive exercise can be instructed to limit their workouts and stick to less strenuous routines. Diet-induced hypothalamus dysfunction can be resolved by adopting healthier eating habits and consuming a nutritionally balanced diet. Women who are diagnosed with an eating disorder may require counseling or hospital treatment before we can determine that drug therapy is needed to treat amenorrhea. If dietary and lifestyle changes don’t work, fertility drugs or oral contraceptives may be prescribed to trigger hormone regulation and restore ovulation and menstruation.
Women who develop hypothalamic amenorrhea have a higher risk of developing osteoporosis and cardiovascular disease later in life. Decreased estrogen levels associated with hypothalamic dysfunction can contribute to bone loss and compromise cardiovascular function. Medications may be given to reduce the risk of these secondary conditions, but should not be taken by women who are or may become pregnant.
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