There is also evidence that the age of menopause, itself, is a potent biomarker of the general ageing state of the individual. *P < 0.001. There are other myths regarding hypothalamic amenorrhea. The hypothalamus is a regulatory center in the brain that releases hormones, which control multiple bodily systems, including the reproductive system. I started my recovery from hypothalamic amenorrhea when my BMI was very normal, 22.1, to be exact. The main analysis was the pre-to-post change of sex and growth hormones, cortisol, total body fat mass, bone mineral density in the spine. However, since there are many factors that can influence exercise performance, the effect of the menstrual cycle on muscle strength is probably very individual-specific and hence, the effect of menstrual cycle status on hormonal responses to acute resistance exercise is not clear. And notice the positive changes that you should be start seeing soon, like more energy, better skin, improved sleep etc and focus on them. The effects of catecholamines on CRF secretion remain controversial. Considerable evidence suggests that both serum FSH and serum inhibin are biomarkers of the number and/or quality of follicles remaining in the ovary. Thanks for reading my blog!! ALLO (3alpha5alpha and 3alpha5beta isomers) binds with high affinity to various gamma-aminobutyric acid (GABA) receptor A subtypes and facilitates the action of GABA at these receptors. Secondary amenorrhea is also caused by stress, extreme weight loss, or excessive exercise. Thank you SO much for your kind words, it means a lot! Just wanted to let you know that I can feel all the energy you spread here at this blog! further the role of the hypothalamic–pituitary–adrenal axis in HA. Women with menstrual disorders associated with low serum estradiol and progesterone levels have an attenuated anabolic hormone response to acute resistance exercise, suggesting that menstrual disorders characterized by low ovarian hormone levels may affect exercise-induced changes in anabolic hormones in women. The regional differences in brain steroid levels imply different local mechanisms for steroid uptake and binding. We also studied patients with bulimia whose weight was normal, since this disorder has been suspected to be a variant of anorexia nervosa. This domino effect, coupled with their participation in physical activities, greatly amplifies their susceptibility to stress fractures. The probability of being menopausal increases with the duration of amenorrhea and age. Despite my “healthy weight” (whatever the hell that means) and re-discovery of my aversion to exercise, nothing seems to be going on down there. I’ve been considering restricting and exercising again. Our work proposes to determine original actions of gonadotrophins on breast cancer cells and may have clinical implications for the use of drugs that modulate gonadotrophins in breast cancer patients. I’ve joined the HA support group on facebook and am all in again since today. Hi Erin, please don’t do it! But her guess is that she was about 67kg (148 lbs) for the last few … The participants were randomly assigned a training program consisted of high frequency leg resistance training, periodized to the first two weeks (group 1) or the last two weeks (group 2) of each cycle, or to a control group performing regular training, during four consecutive menstrual/OC cycles. In the article, they also mention that your BMI may be normal but your fat percentage may be too low. Amenorrhoea caused by weight loss, excessive exercise, stress, or chronic illness should be managed in primary care after an endocrinologist has assessed and excluded other hypothalamic or pituitary causes (such as a tumour). We further examined the participants' own experience of the training programs. The hypothalami were obtained from routine autopsy of patients suffering from no obvious neuroendocrinological abnormality. The primary factor influencing the transition from regular menses to the perimenopause and subsequent menopause appears to be the size of the residual primordial follicle pool. I’m devastated. But her guess is that she was about 67kg (148 lbs) for the … Basal hormonal profiles and GnRH and Naloxone tests for LH (Luteinizing Hormone) and for LH and cortisol responses, respectively, were performed before and after two weeks of administration of a very low dose of estradiol (2.5 ng two times a day). It is classified as hypogonadotropic hypogonadism. Low libido, exhaustion, feeling cold… My BMI was over 22 too when I started recovery, so BMI may not prove anything. I would be really grateful to hear some advise from you, because at the moment I want nothing more than my cycle and my old life back! Conversely, Wildt and Leyendecker (12) and Wildt et al. Significant weight loss (10 pounds or more) can be a trigger for hypothalamic amenorrhea—even if the end weight is still considered “normal.” We measured basal serum levels of FSH, LH, and estradiol and evaluated ACTH, allopregnanolone and cortisol responses to CRH test in both HA patients and healthy women. Hypothalamic amenorrhea is usually caused by stress (could be dieting, exercising, stress in personal or work life etc), and, thus, can occur in normal weight women. Whose fat percentages are not in single digits but who still have hypothalamic amenorrhea? We hypothesized that leptin levels are decreased in women with hypothalamic amenorrhea and that leptin may be a sensitive marker of overall nutritional status in this population. Vasopressin concentrations were maximum in the supraoptic nucleus, followed by the paraventricular and infundibular nuclei. I appreciate it a lot , I’m in tears reading this. I’ve suffered from HA for at least 4 1/2 years since going off the pill, but know that I was suffering for long before that while on the pill. Neuroactive steroids are natural or synthetic steroids that rapidly alter the excitability of neurons by binding to membrane-bound receptors such as those for inhibitory and (or) excitatory neurotransmitters. Hypothalamic amenorrhea with normal body weight: ACTH, allopregnanolone and cortisol responses to corticotropin-releasing hormone test March 2000 European Journal of Endocrinology 142(3):280-5 “Most commonly, it can be treated hormonally,” he says. With this approach I have gained almost 20 pounds in four months. Sometimes you feel alone. They don't even mention that this is an option; the idea we get is that hypothalamic amenorrhea only happens to women whose BMIs or body fat percentages are very low. HOWEVER. For example, I don't think it's helpful to blame social media or fitness magazines for feeding us certain stories and images of what “fit” looks like. Towards the end of that time my BMI was 20, but it was probably a bit lower before that. This phenomenon occurs specifically during the reproductive cycle and is important in that it synchronizes the maturation of the graafian follicles, responsible for the estradiol signal and containing the soon-to-be ovulated oocytes, with the stimulus to ovulation, the preovulatory GnRH/LH surge. Please consult your doctor with any medical issues before beginning a training program. The thing with BMI is, I actually totally agree with you. The LH response to the GnRH test improved in terms of the peak amplitude, as evaluated using Instantaneous Secretory Rates (ISR) computation. Or will I always have a tendency to HA? In someone with hypothalamic amenorrhea, OCPs mask when a natural menstrual cycle resumes. I am not a licensed medical doctor. Clinical characteristics and FSH, LH, estradiol and other baseline hormonal values of women with hypothalamic amenorrhea and control subjects. [ii] It is defined as an absence of menses for more than 6 months with normal … My natural body is bigger, I just didn't know it because I was working out really hard every day to keep it smaller and leaner, many years of my life. Results: The treatment improved both gonadotropins, mainly LH. The thing is – the relationship between weight and hypothalamic amenorrhea is different for everybody. We hypothesized that the increase of ALLO brain content induced by treatment with SSRIs could contribute to alleviating the anxiety and dysphoria associated with the symptomatology of major unipolar depression. Hatched bars, amenorrheic patients (HA), solid bars, control group. Design: We included 8 patients (aged 23.16 61.72 years) suffering from hypothalamic stress-related amenorrhea with normal body weight and 8 age-matched healthy controls in the follicular phase of the menstrual cycle. There are women who start at BMI of 17 and have to get up to 22. Thank you so much!! ormone (FSH) and luteinizing hormone (LH) may also play a role, yet this remains elusive. Hypothalamic amenorrhea (HA) is a common disorder associated with hypoestrogenemia and has adverse effects. Three main types of FHA have been recognized as stress, weight loss, or exercise. Sometimes you feel hurt. My job has been very stressful and incredibly tiring but I don’t feel I let it get to me and I have been off for this last week, extremely relaxed. We forget our individuality and uniqueness. But there are also women whose BMI is already normal when they start the whole journey. The relationship between FSH secretion, ageing and feedback inhibition by oestradiol, inhibin, or other presently unmeasured factors in women with regular menses, remains to be elucidated. When chronic stress is combined with intense exercise and insufficient calories, … It is often seen in the setting of stress, weight loss, or excessive exercise. Recently, the role of corticotropin-releasing hormone (CRH) and neurosteroids in the pathophysiology of HA has been considered. have evaluated women post-mortem concentrations of allopregnanolone in brain cortex, amygdala, hippocampus, caudate nucleus, putamen, thalamus, and the highest levels were observed in the substantia nigra and basal hypothalamus [2]. Hypothalamic amenorrhea is cessation of menses caused by disorders that interfere with normal hypothalamic- pituitary-ovarian axis activation. Thank you so much for bringing to light the fact that those statistics are not facts and it’s all up to our bodies. According to the American Society of Reproductive Medicine, FHA is responsible for 20–35 % of secondary amenorrhea cases and 3% of primary amenorrhea cases . My BMI was 21, which is normal, but my doctor still thought gaining weight might help, hence the exercise less and eat more treatment plan. The aim of this paper is to present a review on the pathophysiology, clinical findings, diagnosis, and management approaches of FHA in adolescent girls. To this end some studies have demonstrated that the responses of anabolic hormones to acute resistance exercise in women vary with menstrual cycle status. As you probably know, being fit doesn't mean only fitting in one certain body type or size. The better way is to work with your mindset so that these things stop affecting you. ... they may appear to be relatively normal weight … It's important to know that the diet industry is just a money making machine, that fitness images on Instagram are often photoshopped or showcasing people who are very lean but unhealthy — we just can't see that because all we see is the beautiful body. After I went to 115 lbs in December, I got my diagnosis in February and with it finally the answers that I’ve been searching for so long. . No significant negative impact on sex and growth hormones, cortisol, total body fat mass and bone mineral density in the spine, was detected in any of the groups. We lose the weight again, and next time, it may take even MORE weight to get the period back again. I was well on my way to recovery a year ago. In moments like this, know that your health is more important than your looks, and that your healthy may look very different from someone else's healthy. The purpose of this study was to investigate potential negative effects of high frequency periodized menstrual/OC cycle based leg resistance training on components in the female athlete triad. The treatment for amenorrhea will depend on what is causing it, Dr. Kramer says. There are numerous physiological alterations, which occur in response to stressors and which are essential in modifying the internal milieu to allow for the body response to the stress challenge. Conclusions: Our study supports the relevance of very low dose estradiol priming to promote and restore impaired neuroendocrine function in patients with FHA. FHA is therefore classified as a form of hypogonadotropic hypogonadism, which results in a hypoestrogenic state (8,12. Baillière s Clinical Endocrinology and Metabolism. Unfortunately I relapsed and have since lost the weight and the second time around is so hard. Functional hypothalamic amenorrhea (FHA) is a common cause of amenorrhea in adolescent girls. menstruating regularly, while serum inhibin levels are decreased in both the follicular and luteal phases. I will think about it and get it touch with you when I need your support again. So after reading several blogs about HA (including yours) I started to follow the recovery plan and only about two weeks later, after I’ve gained back to 122 lbs, I got my first period after almost nine months! *P < 0.001 compared with HA group. For more on HA, see my posts Signs and Symptoms of Hypothalamic Amenorrhea, Overcoming Hypothalamic Amenorrhea, and Hypothalamic Amenorrhea Treatment. Patients with primary or secondary amenorrhea should be evaluated for other causes of amenorrhea before a diagnosis of FHA can be made. However, hypothalamic amenorrhea is more common among women with BMIs around 20 or below. Some neurosteroids act as GABA-A agonists, such as allopregnanolone and tetrahydrodesoxycorticosterone; others are GABA-A antagonists, such as DHEA and pregnanolone sulfate (Figure 1). Significant weight loss (10 pounds or more) can be a trigger for hypothalamic amenorrhea—even if the end weight is still considered “normal.” Stress: Physiological stress can be a factor in developing hypothalamic amenorrhea (and exercise can be interpreted by the body as a form of physiological stress). The most common form of secondary amenorrhea is hypothalamic amenorrhea. I really can’t describe how happy I was! In patients with FHA, studies have shown that GnRH secretion is suppressed, LH pulsatility is impaired (8,9,10,11), and total LH and FSH levels are reduced (11,12,13,14). The CSF content of PREG and PROG remained unaltered after treatment and failed to correlate with the SSRI-induced increase of CSF ALLO. Hypothalamic Amenorrhea. Causes of secondary amenorrhea can also result in primary amenorrhea, especially if present before onset of menarche. The hypothalamus is an area of the brainthat plays a central role in maintaining the balance of body systems. Thank you so much, I’m so sorry to hear that you’re struggling with this! Biochemical and electrophysiological studies have shown that these steroids markedly augment GABA-activated chloride ion currents in a manner similar (but not identical) to that of anesthetic barbiturates. Functional hypothalamic amenorrhea (FHA), a diagnosis of exclusion, occurs in normal weight, nonathletic women and has no apparent cause. I gained twenty pounds and still wasn’t getting my period but I feel I was close. Unilateral section of ascending norepinephrine-containing neurons leads to an ipsilateral decrease in paraventricular CRF content. Moreover, the women in group 1 experienced their training program as positive. Moreover, a statistically significant correlation (r = 0.58; P < 0.023; n = 15) existed between symptomatology improvement (Hamilton Rating Scale for Depression scores) and the increase in CSF ALLO after fluoxetine or fluvoxamine treatment. When it comes to becoming overweight – remember, this 25 on the BMI scale is also a number than can be quite arbitrary. Also commonly referred to as functional hypothalamic amenorrhea (FHA), HA is characterized by three main types … I will continue to work on minimising stress levels. Fecundability begins to decline by the age of 29 years. I have been eating well still and not exercising. The stress of intense workouts places these female athletes at a greater risk than the general female population. All rights reserved. I know girls who have started their recovery over again and it’s so much harder the second time around. There have been a number of studies about the effects and influence of the menstrual cycle on aerobic and anaerobic performance, but most studies that investigated muscle strength responses to resistance exercise over the menstrual cycle have not found any changes. Functional hypothalamic amenorrhea is a disorder of chronic anovulation caused by suppression of the hypothalamic-pituitary axis from body weight loss, … That’s interesting Christina. Bone density is huge… You can’t be active at your older age when your bones are brittle. But I get so sad when I see girls get it back after gaining “20 pounds” and oh I wish that was all I had to gain…. And the next month I got another period! An improved muscle strength are of great importance in many sports, hence an increased understanding on how to generate optimal strength training programs in women without negative side effects that may lead to the female athlete triad are essential. All views expressed on this website are based on my own personal research and experiences.