If a woman misses a period, it has commonly three implications for the common man-either she is pregnant , is lactating or has hit menopause. But there is a medical condition in which the periods are absent due to some other problem. This condition in which the periods are absent due to some physical deficiency is known as Hypothalamic Amenorrhea. It is also called hypothalamic hypogonadism, (“HYPO HYPO”). This condition is characterized by the absence or cessation of menstruation due to the deficiency of GnRH pulsatile secretion. When the secretion of GnRH is below a critical level, then it results in a low level of FSH, estrogen and LH hormones. This condition can be seen in about 3-5 % of the female population.
- Anovulation polycystic ovary
- Excessive weight loss
- Eating disorders like anorexia and bulimia
- Hypothalamic suppression,
- Drug abuse
- Excessive exercise
- A genetic defect such as kallmann’s syndrome
- Adrenal hypoplasia.
- The diagnosis is done by confirming the prolactin and thyroid stimulating hormone levels.
- Imaging of the brain may be advised along with imaging of sella turcica (Speroff)
- lab tests such as β-HCG, FSH (decreased or normal), Testosterone Level LH, estrogen, TSH, and Prolactin, may be suggested
- Ultrasound: to check the size of the ovary, antral Follicle count and endometrial thickness is suggested.
- Empty Sella Syndrome
- Sheehan Syndrome
- Pituitary Tumor- Prolactin Secreting
- Low GnRH Secretion- Dysfunctional Hypothalamus
- Hyperandrogenism/ Polycystic Ovary
- Asherman Syndrome (Intrauterine Adhesions)
- Premature Ovarian Failure
- Rare Causes may include- lymphoma(Abnormality of Hypothalamus ), histiocytosis X, sarcoidosis, and hypothalamic cysts
Treatment of HYPO HYPO includes the following -
- If the doctor suspects the underlying reasons to be stress or excessive exercise, then the reversing the conditions is suggested. This includes reducing stress and decreasing the amount of exercise. n cases where excessive weight loss is suspected, then the patient is advised to gain some weight. In such cases, simple tips to increase the calorie count and decrease the expenditure of energy is suggested by the doctor.
- Women with this problem may be suffering from anorexia which may lead to other conditions such as low bone density, which is quite difficult to reverse. Such patients need to undergo exogenous cyclic estrogen/ progestin therapy or be on a contraceptive pill to avoid bone loss. They may also need vitamin D supplements along with calcium.
- Psychological support matters a lot to such women. It is significant that the doctor includes the family while discussing the treatment. It will also pay to seek professional psychological help in such cases.; People with eating disorders are actually suffering from psychological problems.
- Pulsatile GnRH may be used for stimulating the ovulation process. It may lead to overstimulation and result in multiple births. In such cases, it is recommended that the treatment be used along with IVF. minimum/elective embryo transfer may also be used. Tackling behavioral problems and providing advice to the patient on having a nutritional diet during pregnancy must be considered so that fetal growth is proper and normal.